Jarmila Vojtková, Miriam Čiljaková, Ján Mikler
Background: Associated autoimmune diseases, especially autoimmune thyroiditis (AT) and celiac disease, are typical for type 1 diabetes mellitus (T1D). The aim of the study was to establish the prevalence of associated diseases in children with T1D and find their influence on autonomic functions and selected parameters. Patients and methods: 155 children (77 males and 78 females) with T1D at the age 8-19 years (average 13.61 ± 4.16 years) were enrolled to the study. Basic anthropometric and biochemical parameters (fasting glycemia, glycosylated hemoglobin, cholesterol, triglycerides, C-peptide, microalbuminuria, TSH, free thyroxin, antibodies against thyreoperoxidase, thyreoglobulin and tissue transglutaminase) were established. AT was defined as minimally three-times increased titer of at least one antibody (anti-TPO, anti-Tg) and celiac disease was defined based on histology of duodenum biopsy. All patients were examined by heart rate variability by system VariaPulse TF4 (DimeaGroup, Olomouc, Czech Republic) and spirometry examination by system Koko DigiDoser Spirometry (nSpire Health, Lousiana, USA). Results: AT was present in 36 patients (23.22 %) and all patients were eufunctional on substitutional therapy. Celiac disease was confirmed in 7 patients (4.52 %). Subjects with T1D and AT had significantly lower parameters of heart rate variability – total power, MSSD, RR interval and CCV Hi that reflect the autonomic dysfunction in these patients. No significant difference was found in other observed parameters. Similarly, no significant difference was found in any monitored parameters between patients with and without celiac disease. Conclusion: In patients with T1D and AT, dysfunction of autonomic nervous system was found. The question is, if the presence of AT contributes to development of autonomic dysfunction in patients with diabetes or if autonomic dysfunction is the result of complex interaction of patomechanisms where genetic predisposition to autoimmune diseases leading to T1D and AT plays a role. Further studies are useful for more accurate assessment of indicated associations with higher number of participating individuals.