CC BY
42
Sadirkhodjaeva Azizakhon Alavitdinovna, Doctoral student of the 1st course of the PhD of the Department of Pediatric Diseases, Hematology Tashkent Pediatric Medical Institute E-mail: [email protected] Ashurova Dilfuza Tashpulatovna, doctor of medical sciences, associate professor, head of the department: propedeutics of children's diseases, hematology Tashkent Pediatric Medical Institute
PREDICTION OF OCCURRENCE AND THE RELATIONSHIP OF AUTOIMMUNE DISEASES IN CHILDREN WITH TYPE 1 DIABETES
Abstract. Autoimmune diseases of the thyroid gland (AIT) are the most common autoimmune diseases associated with type 1 diabetes. The development of hypothyroidism in patients with type 1 diabetes is associated with worsening of metabolic control and an increase in hypoglycemic states. Slowing down the process of insulin degradation in hypothyroidism reduces the need for patients with type 1 diabetes in exogenously administered insulin, which leads to the development of hypoglycemia
Keywords: diabetes mellitus; autoimmune diseases; diffuse goiter; diabetic cardiomyopathy.
Introduction. Autoimmune diseases of the thyroid ministered insulin, which leads to the development of hypo-
gland (AIT) are the most common autoimmune diseases glycemia [2]. Celiac disease manifestation is often associated
associated with type 1 diabetes [1]. AIT is diagnosed when with T1DM and in most cases is presented in the form of sub-
three "large" signs are detected: primary hypothyroidism clinical forms. The frequency of occurrence of celiac disease
(manifest or subclinical), the presence of antibodies to the thyroid gland in the blood, and ultrasound signs of autoimmune thyroid damage [3]. In some patients, despite the presence of antibodies to the components of the thyroid gland, its function is not impaired. In a prospective study, it was found that in patients with elevated levels of AT to TPO, hypothyroidism develops annually in 4.3% of them. The rates of disease progression were directly dependent on the initial level of AT to TPO [4]. According to epidemiological data, in case of T1DM, the frequency of occurrence of thyroid disease increases 2 times [5].
The development of hypothyroidism in patients with type 1 diabetes is associated with worsening of metabolic control and an increase in hypoglycemic states. Slowing down the process of insulin degradation in hypothyroidism reduces the need for patients with type 1 diabetes in exogenously ad-
among patients with type 1 diabetes is much higher than that in the general population and, according to various sources [1; 2], ranges from 1 to 8% (compared with 0.5% in the general European population). In the debut of type 1 diabetes, celiac disease is diagnosed in 2.5% to 3% of cases.
Objective: to establish the frequency of occurrence of concomitant diseases in children with type 1 diabetes.
Material and methods. 46 children aged from 8 to 17 years with diabetes mellitus lasting from several months to 15 years were examined. The average age of children was 13.3 years. For the period of the survey, none of the patients had ketoacidotic and hypoglycemic conditions. All children were divided into 2 groups depending on the duration of the disease. Group 1 comprised 20 children with diabetes mellitus up to 5 years, Group 2-26 children with a disease duration of more than 5 years.
Figure 1. Distribution of children according to the experience of morbidity
Section 6. Medical science
The general characteristics of the examined patients provided for the collection of anamnestic data, including the time and nature of the onset of the disease, the course and duration of the disease, the hereditary predisposition to diabetes, a history of the child's life, past diseases, and an assessment of the patient's general condition. The diagnosis was made on the basis of complaints, anamnesis, physical examination, laboratory and instrumental data. Statistical data processing was performed using descriptive statistics in the form of arithmetic mean and its standard
error, Spearman correlation analysis. Statistical processing was performed using the application package "Biostat" and "Excell 2013".
Results. The basis of the development of late complications of diabetes in children, including the cardiovascular system, are metabolic disorders associated with poor compensation of the disease, which, according to our data, goes out of control when the duration of diabetes is more than 5 years. This is confirmed by the close direct correlation of the gly-cated hemoglobin level with the duration of the disease.
Figure 2. Correlation between experience of the disease and glycated hemoglobin
Notes: X axis - the values of the experience; Y - the values of glycated hemoglobin
When comparing data from the experience of the disease and glycated hemoglobin, the direct reliable relationship was established, i.e. with an increase in experience, glycated hemoglobin increases. Given the above data, the duration of the disease and the level of HbAlc, as an indicator of metabolic
imbalance, reliably correlates with organ and systemic complications. It can be assumed that the leading value in the development of organ pathology is not the maximum peaks of the rise in glucose concentration in the blood, but long-lasting hyperglycemia.
Figure 3. Concomitant pathology of patients with type 1 diabetes
Consequently, in children with diabetes mellitus over 5 years, the risk of developing late complications of the disease increases, which requires close attention of physicians with the aim of their early detection and timely prevention of further.
Type 1 diabetes mellitus is an autoimmune disease associated with the destruction of insulin-producing ^-cells of the pancreas, the genesis of which involves many genetic and immunological factors. When T1DM, antibodies to |?-cells are present.
The result of the study shows that type 1 diabetes is more common with diffuse goiter (48%), and with other autoim-
mune pathologies such as celiac disease, bronchial asthma, systemic lupus erythematosus, juvenile rheumatoid arthritis, reactive hepatitis occur in equal amounts (2%).
Conclusions. Thus, based on the above, children with type 1 diabetes have an increased risk of developing other autoimmune diseases. Early detection in autoimmune diseases of latent dysfunction of target organs that will prevent the development of severe and in some cases life-threatening complicated clinical signs of the disease that can worsen the course of diabetes.
References:
1. Driessche A., Eenkhoorn V., Gaal L., Block C. Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review. Netherlands J Med 2009; 67: 11: 376-387.
2. Prazny M., Skrha J., Limanova Z., Vanickova Z., Hilgertova J., Prazna J., Jaresova M., Striz I. Physiol Res 2005; 54: 41-48.
3. Dedova I. I., Melnichenko G. A. Endocrinology. National leadership. Ed.- M.: Geotar Media 2008; 741-750.
4. Vanderpump M. P.J., Tunbridge W. M., French J. M., Appleton D., Bates D., Clark F., Grimley E. J., Hasan D. M., Rodgers H., Tunbridge F. The twenty-year follow - up of the Whickham survey. Clin Endocrinol 1995; 43: 55-68.
5. Reismann P., Somogyi A. Diabetes and thyroid disorders. Orv Hetil 2001; 152: 13: 516-519.
