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Comorbidities in type 1 diabetes

20th September 2022

Many people with diabetes have to cope with the significant health challenges presented by living with more than one chronic condition. To launch EASD e-Learning’s new course on conditions commonly associated with type 1 and type 2 diabetes, Professor Bruce Wolffenbuttel’s module focuses on comorbidities in type 1 diabetes.

Comorbidities in type 1 diabetes – not only other autoimmune-related conditions but obesity too – have significant implications for treatment and quality of life. “We all think of diabetes as a glucose disease where we to try to attain as good control as possible,” says Professor Bruce Wolffenbuttel, Emeritus Professor of Endocrinology and Metabolism at the University of Groningen, The Netherlands. “We try to treat hypertension and try to treat dyslipidaemia. But other diseases that coincide with type 1 diabetes also need attention from the diabetes team – they should be an integral part of diabetes care.”

Obesity, although more commonly discussed in the context of type 2 diabetes and not strictly speaking a comorbidity, is the first topic Bruce addresses in his module. It’s an important issue for people with type 1 diabetes, with long-term follow-up in the DCCT EDIC study showing sizeable increases in body weight over time. As Bruce points out, intensive insulin treatment may itself play a part in this – not least by encouraging excessive carbohydrate intake to combat hypoglycaemia. Whatever the cause, this weight gain translates into significant consequences for both the treatment of diabetes and the development of complications (cardiovascular, in particular) – raising blood pressure and increasing both intima-media thickness and coronary calcifications.

The module’s main focus, though, as might be expected, is on autoimmune comorbidities. As a condition that originates in autoimmunity, it makes sense that type 1 diabetes should overlap with other autoimmune disorders, and Bruce shows data from the UK Biobank that explains, at least in part, why some of these so often go hand in hand. Type 1 diabetes, hypothyroidism and coeliac disease, for example, all share a similar risk in the HLA system, located on chromosome 6. 

Of the autoimmune comorbidities associated with type 1 diabetes, the most prevalent are the thyroid disorders, coeliac disease and vitamin B12 deficiency –  all of which have a significant impact on quality of life. These are all explored in detail. Bruce’s central point – that identifying and treating these comorbidities should be an integral part of the care provided by the diabetes team – is well served by this module, which provides vital information practitioners will require to plan the diagnosis, monitoring and treatment of people with type 1 diabetes and comorbidities.

For Professor Wolffenbuttel’s module, ‘Type 1 diabetes and comorbidity’, enroll on the new EASD e-Learning course ‘Multimorbidity and diabetes’, launching today.Professor Wolffenbuttel will be participating in a live EASD e-Learning Q&A session with Professor Cees Tack titled ‘Comorbidities in type 1 and type 2 diabetes’ at the EASD conference on Tuesday 20th September at 13.00 in the Virchow Hall.