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High prevalence of antithyroid peroxidase and antiparietal cell antibodies among patients with type 1 diabetes mellitus attending a tertiary diabetes centre in South Africa
  1. Imran M Paruk1,
  2. Yasmeen Ganie2,
  3. Sureka Maharaj1,
  4. Fraser J Pirie1,
  5. Vasudevan G Naidoo3,
  6. Ntombifikile M Nkwanyana4,
  7. Hilary L Dinnematin5,
  8. Pratistadevi K Ramdial6,
  9. Ayesha A Motala1
  1. 1Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
  2. 2Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
  3. 3Department of Gastroenterology and Hepatology, University of KwaZulu-Natal, Durban, South Africa
  4. 4Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
  5. 5Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
  6. 6Department of Anatomical Pathology, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
  1. Correspondence to Dr Imran M Paruk, Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa; paruki{at}ukzn.ac.za

Abstract

Objective Data on the prevalence of autoimmune thyroid disease (AITD) and gastric autoimmunity in type 1 diabetes mellitus (T1DM) in Africa are limited. The aim of this study was to assess the prevalence of antithyroid peroxidase (TPO-A) and antiparietal cell antibody (PCA) in patients with T1DM at a tertiary diabetes clinic in Durban, South Africa.

Research design and methods This was a cross-sectional observational study among subjects attending the adult T1DM clinic at Inkosi Albert Luthuli Hospital. Information about history and clinical examination was collected. Blood tests included glutamic acid decarboxylase antibody (GADA), TPO-A, PCA, vitamin B12, folate, ferritin, thyroid stimulating hormone (TSH), free thyroxine, lipids and HbA1c.

Results A total of 202 (M:F, 90:112) patients were recruited. The ethnic composition was African (black) (56.4%; n=114), Indian (31.7%; n=64), white (4.5%; n=9) and coloured (mixed race) (7.4%; n=15). Mean age and mean duration of diabetes were 26.4±11.4 and 10.7±9.1 years, respectively. Mean body mass index was 21.6±6.3 kg/m2. GADA was positive in 63.37% (n=128). The prevalence of TPO-A was 18.9% (n=39) and PCA 8.9% (n=17). The prevalence of overt hypothyroidism, subclinical hypothyroidism and Graves' disease was 10.9%, 2.5% and 1.5%, respectively; vitamin B12 deficiency was noted in 3.5% (n=7) and iron deficiency in 19.3% (n=39).

Conclusions Among patients with T1DM in this study, there was a high prevalence of coexistent AITD and gastric autoimmunity. Screening for hypothyroidism and thyroid autoimmunity should be undertaken in all patients at initial presentation. However, to assess the feasibility and optimal timing of subsequent testing in the African setting with limited resources, more collaborative research with longitudinal studies is required.

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Footnotes

  • Contributors All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication. Conception or design of the work (IMP, FJP, PKR and AAM); data collection (IMP, YG, SM, FJP, VGN, HLD, PKR and AAM); data analysis and interpretation (IMP, NMN and AAM); drafting the article (IMP, FJP, VGN, PKR and AAM); critical revision of the article (IMP, FJP, PKR and AAM); final approval of the version to be published (IMP, YG, SM, FJP, VGN, NMN, HLD, PKR and AAM).

  • Competing interests None declared.

  • Ethics approval University of KwaZulu-Natal Biomedical Research Ethics Committee (UKZN BREC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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