Acta Paediatr. 2021 Apr;110(4):1353-1358. doi: 10.1111/apa.15643. Epub 2020 Nov 18.

Hildegard Jasser-Nitsche ¹, Susanne Bechtold-Dalla Pozza ², Elisabeth Binder ³, Esther Bollow ⁴, Bettina Heidtmann ⁵, Young Hee Lee-Barkley ⁶, Klemens Raile ⁷, Gideon de Sousa ⁸, Ursula Schramm ⁹, Reinhard W Holl ⁴

Author information

• ¹Department of Paediatrics, Medical University of Graz, Graz, Austria.
• ²Paediatric Endocrinology and Diabetology, Ludwig-Maximilians Medical University Munich, Munich, Germany.
• ³Department of Paediatrics, Medical University Innsbruck, Innsbruck, Austria.
• ⁴Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, and German Centre for Diabetes Research, DZD, Munich-Neuherberg, Germany.
• ⁵Department of Paediatric Endocrinology and Diabetology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
• ⁶Department of Endocrinology, Heart- and Diabetes Centre NRW, Bad Oeynhausen, Germany.
• ⁷Department of Paediatric Endocrinology and Diabetology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
• ⁸Department of Paediatrics, Klinikum Dortmund gGmbH, and Department of Paediatrics, University of Witten/Herdecke, Witten, Germany.
• ⁹Department of Paediatrics, Oberlausitz-Kliniken gGmbH Bautzen, Bautzen, Germany.

Abstract

Aim: To determine the prevalence of inflammatory bowel disease (IBD) in patients with type 1 diabetes (T1D) and to characterise patients with both diseases.

Methods: Data of 65.147 patients with T1D ≤18 years of 379 centres in Germany and Austria participating in the DPV initiative were analysed. A total of 63 children had comorbid IBD; IBD prevalence was 0.1%. Regression models were used to analyse differences in metabolic control, acute complications and steroid intake.

Results: Mean BMI-SDS in patients with T1D and IBD was lower (-0.15 ± 0.11) compared to patients with T1D only (0.27 ± 0.00, p < .001). Patients with T1D and IBD had a significantly higher use of steroids (22% ± 0.05% vs. 1% ± 0.00, p < .001) and a significantly higher rate of severe hypoglycaemic events per patient year (0.33 ± 0.07 vs. 0.16 ± 0.00, p = .001). No differences were found in HbA1c levels, insulin dose and occurrence of DKA.

Conclusion: Although children and adolescents with T1D and IBD take steroids more often, they suffer from severe hypoglycaemia more frequently and have a lower BMI-SDS. These findings might be explained by chronic intestinal inflammation leading to malabsorption, malnutrition and increased severe hypoglycaemia.