In adults living with type 1 diabetes, additional autoimmune diseases are associated with more chronic complications and depression. A BETTER registry analysis - 21/06/25

Doi : 10.1016/j.diabet.2025.101667

Cassandra A.A. Locatelli ^a,^b,^c, Meryem K. Talbo ^c,^d,^e, Virginie Messier ^c, Caroline Grou ^c, Maha Lebbar ^c, Erin E. Mulvihill ^a,^b,^f,^g, Anne-Sophie Brazeau ^c,^e, Rémi Rabasa-Lhoret ^c,^f,^h,^i,^⁎
^a The University of Ottawa, Faculty of Medicine, Department of Biochemistry, Microbiology and Immunology, Ottawa, ON K1H 8M5, Canada
^b The University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y4W7, Canada
^c Institut de recherches cliniques de Montréal (IRCM), 110 avenue des Pins Ouest, Montréal, QC H2W 1R7, Canada
^d Stanford University, Department of Medicine, Division of Endocrinology, 300 Pasteur Drive, Stanford CA 94305-5103, USA
^e McGill University, Faculty of Agricultural and Environmental Sciences, School of Human Nutrition, 21,111 Lakeshore Road, Ste. Anne de Bellevue, QC H9X3V9, Canada
^f Montreal Diabetes Research Centre, CRCHUM-Pavillion R, 900 Saint-Denis-Room R08.414, Montreal, H2X0A9, QC, Canada
^g Centre for Infection, Immunity and Inflammation, The University of Ottawa, 451 Smyth Rd, Ottawa, K1H 8M5, ON, Canada
^h Université de Montréal, Faculty of Medicine, Department of Nutrition, 2900 Boul Edouard-Montpetit, Montreal QC H3T1J4, Canada
ⁱ Department of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC H2X0C1, Canada

^⁎Corresponding author at: Institut de recherches cliniques de Montréal (IRCM), 110 avenue des Pins Ouest, Montréal, QC H2W 1R7, Canada.Institut de recherches cliniques de Montréal (IRCM)110 avenue des Pins OuestMontréalQCH2W 1R7Canada

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Highlights

•	36 % of BETTER participants report autoimmune disease (AD) on top of type 1 diabetes.
•	People with type 1 diabetes and AD+ reported higher rates of chronic complications.
•	People with type 1 diabetes and AD+ reported higher rates of level 3 hypoglycemia.
•	AD+ in type 1 diabetes was associated with depression and anxiety medication use.
•	The number of AD+ is positively associated with complications and depression scores.

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Abstract

Aim

People living with type 1 diabetes (T1D) are at elevated risk of additional autoimmune diseases (ADs) than the general population. We aimed to describe the association between additional ADs and T1D-related physical and mental burden in adults.

Methods

This was a cross-sectional analysis using data from the BEhaviors, Therapies, TEchnologies, and hypoglycemic Risk in T1D (BETTER) registry. Using patient reported-outcomes and validated questionnaires, we compared prevalence of vascular complications, hypoglycemia, and mental health issues between those with T1D alone (AD-) and T1D with additional AD (AD+).

Results

Among 3222 participants (66.2 % female, 42.7 ± 15.0 years), 36.3 % reported ≥ 1 AD+. The AD+ group was older (+4.4 years) and more female (+17.7 %) than the AD- group. The AD+ group had similar HbA1c (P = 0.20) but was more likely to report level 2 hypoglycemia in the past month (OR: 1.27 [95 %Cl 1.06–1.52]) and level 3 hypoglycemia since diagnosis (1.22 [1.05–1.42]). The AD+ group reported more cardiovascular disease (1.40 [1.03 to 1.90]), nephropathy (1.49 [1.19–1.86]), neuropathy (1.38 [1.13–1.69]), retinopathy (1.48 [1.22–1.78]), higher depression scores (p = 0.015), and anxiety/depression medication use (1.31 [1.10–1.56]). Number of AD+ was positively associated with depression scores (1 AD+ P = 0.055, 2+ AD+ p = 0.027), level 3 hypoglycemia since diagnosis (1 AD+ p = 0.037, 2+ AD+ P = 0.025), and number of chronic complications (1 AD+ P < 0.001, 2+ AD+ P < 0.001).

Conclusion

For people with T1D, living with additional ADs is associated with higher levels of physical and mental diabetes complications, warranting regular screening in this population.

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