<p>Discover the real-life impact of autoimmune Type 1 Diabetes (T1D) through the perspective of Sigurd’s parents. In this testimonial, they share their experiences of missed early signs, the sudden shock of diagnosis, and the profound impact that T1D has had on their family life.</p>
<p>In this testimonial film, Sigurd’s parents reflect on how they overlooked signs of Sigurd developing autoimmune T1D, the moment of realization, the shock of diagnosis, how their lives changed overnight, and what earlier detection could have meant:</p>
<ul>
 <li>Sigurd’s mother speaks candidly about the toll of constant glucose monitoring device alarms and the emotional strain on their other children.</li>
 <li>Sigurd’s father shares how his lived experience with autoimmune T1D helped them adapt to Sigurd’s diagnosis. He also shares his opinions about whether he would have wanted to know in advance that Sigurd was developing autoimmune T1D.</li>
</ul>

<p>Sigurd’s parent's message to healthcare professionals is clear: <strong>early detection through autoantibody screening has many benefits</strong>. It offers time to prepare, it can support families psychologically, and it can lessen the shock of diagnosis, for everyone whose daily life may be affected by autoimmune T1D.</p>

<h3 style="text-align:center;">Part 1: How parents perceive the risk of their child developing autoimmune Type 1 Diabetes</h3>

<p>Parent's experiences of stage 3 diagnosis of T1D.</p>

TYPE-1-DIABETES

DIABETES

When a Child Gets Autoimmune Type 1 Diabetes

<h3 style="text-align:center;">Part 2: What it is like to discover that your child has autoimmune Type 1 Diabetes</h3>

<h3 style="text-align:center;">Part 3: What it takes to cope with the shock of diagnosis and to adjust to life with autoimmune T1D</h3>

<h3 style="text-align:center;">Part 4: Whether there is value in knowing early on if a family member is developing autoimmune Type 1 Diabetes</h3>

<h3 style="text-align:center;">Part 5: Everyday life with autoimmune type 1 diabetes</h3>

<h3 style="text-align:center;">Full video: When A Child Gets Autoimmune Type 1 Diabetes</h3>

<p>Heeft u vragen of wilt u meer weten? Wij zorgen dat u zo snel mogelijk geholpen wordt.</p>


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Parent's experiences of stage 3 diagnosis of T1D.

<h2>How does uncontrolled atopic dermatitis (AD) impact patients beyond the physical symptoms?</h2>
<h3>In addition to looking at clinical measures, it’s important to consider other ways AD may be impacting patients. Skin lesions and itch are just the tip of the iceberg.</h3>

<p>86% of patients with uncontrolled moderateto- severe AD report suffering from daily itch<sup>1</sup></p>

<p>Patients with moderate-to-severe AD report spending 31%-53% of the year in flare<sup>2</sup></p>

<p>What burdens due to AD do your patients experience in their daily lives?</p>

<p>Understanding the broader consequences of uncontrolled AD and the complexity of its burden on patients’ lives is essential for comprehensive disease management.<sup>1</sup></p>

<p>The itch that is common in AD can have a serious impact on both the quality and quantity of sleep a patient gets. Because of this, the time patients spend sleeping is an important sign of how AD is affecting them.<sup>3,4</sup></p>

<p>In a survey that included over 2000 patients with AD,&nbsp;reported moderate-to-severe sleep disruption due to AD-related itch during the previous week<sup>3</sup></p>

<p>Another study found that&nbsp;<strong>67 nights of sleep, or over 2 months per year</strong>,&nbsp;can be negatively impacted by AD in adults.<sup>2</sup></p>

<h3>This lack of sleep can have a negative impact leading to limitations on many aspects of life, from socializing to working. Sleep disruption can often also affect partners and caregivers.<sup>2,4</sup></h3>

<p>The itch that is so common in AD can have a cascading effect on patients’ lives, leading to sleep disturbances that in turn impact everyday functioning, including adverse effects on participation in activities and social interactions.<sup>2-4</sup></p>
<p>The burden of AD is multifaceted, impacting the skin and so much more. To improve the quality of life of patients, interventions aimed at addressing the pathophysiology of AD are vital.</p>

<p>Beneath the skin of patients with AD—type 2 inflammation and the cytokines involved.</p>

Referenties

Understanding the full scope of AD—the unseen burden on patients.

Sleep and QOL: the full impact on patients coping with the burden of AD

ATOPIC-DERMATITIS

DERMATOLOGY

<p data-font="small">*Polyautoimmunity is the occurrence of ≥2 autoimmune diseases in a single patient;<br>
  †Family autoimmunity presence of ≥2 autoimmune diseases in members of a nuclear family;</p>

<h2 id="comorbidity">Could autoantibodies serve as markers for autoimmunity in T1D?</h2>
<p>In some patients, autoimmune T1D is associated with the presence of additional autoimmune diseases, such as&nbsp;autoimmune thyroid disease, celiac disease, and Addison’s disease, which could lead to the production of organ-specific autoantibodies.<sup>1</sup></p>
<p>Autoantibodies such as insulin autoantibodies (IAA), glutamic acid decarboxylase-65 (GAD-65), islet cell antigen 2 (IA-2), and islet cells autoantibodies (ICA), may be present for years prior to the diagnosis of autoimmune&nbsp;T1D&nbsp;and could serve as markers of autoimmune T1D.<sup>1</sup></p>

<h2 id="prevalence">Do other associated autoimmune diseases frequently coexist with autoimmune T1D?</h2>
<p>Concomitant autoimmune conditions may represent additional burden and complications&nbsp;in patients with autoimmune T1D.<sup>3,7</sup>&nbsp;In the US, the prevalence of autoimmune diseases is higher in Caucasians and women and tends to rise with advancing age.<sup>7</sup>&nbsp;&nbsp;</p>
<p><i>Please refer to the below figure to know more about the prevalence of other associated autoimmune diseases linked with autoimmune T1D.</i></p>
<h3 style="text-align: center;">Prevalence of other associated autoimmune diseases linked with autoimmune T1D<sup>1,2</sup></h3>

<h2 id="familial">Is there a familial association between autoimmune T1D and other associated autoimmune diseases?</h2>
<p>A familial association of T1D with other associated autoimmune diseases has been observed. Several genes linked to T1D risk also increase the chance of other associated autoimmune diseases.<sup>8</sup></p>
<p>The inheritance pattern of autoimmune diseases is complex and involves multiple factors, including the consolidated impact of genotype and environmental triggers.<sup>2</sup></p>
<h3>Risk for autoimmune T1D</h3>
<p>Autoimmune T1D puts first-degree relatives of patients at 1.6-times increased risk. A significant association for singleton siblings was found for autoimmune T1D (SIR = 2.14).<sup>2</sup></p>
<p>Autoantibodies may develop sequentially. First-degree relatives expressing autoantibodies to IAA, GAD-65, and IA-2 had a 75% 5-year risk of diabetes vs 25% 5-year risk in relatives expressing only one of those autoantibodies.<sup>1</sup>&nbsp;People diagnosed with Stage 2 autoimmune&nbsp;T1D have a near 100% lifetime chance of progression to Stage 3 autoimmune T1D,&nbsp;with 75% of them progressing within five years.<sup>9</sup></p>
<h3>Risk for other associated autoimmune diseases</h3>
<p>Family autoimmunity is characterized by presence of ≥2 autoimmune diseases in members of a nuclear family.<sup>2</sup>&nbsp;Autoimmune T1D also confers an increased risk of autoimmune diseases in first-degree relatives, with 8% and &lt;6% developing&nbsp;autoimmune thyroid disease&nbsp;and celiac disease, respectively.<sup>1</sup></p>
<p>In a first population-level study that assessed the familial risks for T1D and a large number of other associated autoimmune diseases using MigMed database found that:<sup>8</sup></p>
<h3 style="text-align: center;">T1D in offspring was associated with the following diseases in parents</h3>

<h3>Individuals with a first-degree relative with T1D have approximately 15-fold increased relative risk of developing T1D<sup>1</sup></h3>

<h2 id="genetic">Do common genetic risk factors overlap for the autoimmune diseases?</h2>
<p>Shared genetic risk factors and immune system dysregulation are potentially implicated both in polyautoimmunity and family autoimmunity among individuals with autoimmune T1D.<sup>2</sup>&nbsp;Human leukocyte antigen (HLA) genotypes, PTPN22 gene, and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4)&nbsp;—&nbsp;all contribute to the complex interplay of genetic factors in autoimmune diseases that overlap with autoimmune T1D,&nbsp;<i>as depicted in the below figure</i>.<sup>1</sup></p>

<table>
 <tbody>
  <tr>
   <td style="width: 30%; background-color: #7a00e6;">
    <h3 style="text-align: center; color: rgb(255, 255, 255);">Genotype</h3></td>
   <td style="width: 35%; background-color: #7a00e6;">
    <h3 style="text-align: center; color: rgb(255, 255, 255);">Disease association</h3></td>
   <td style="width: 35%; background-color: #7a00e6;">
    <h3 style="text-align: center; color: rgb(255, 255, 255);">Additional information</h3></td>
  </tr>
  <tr>
   <td>
    <p><em>HLA</em></p>
    <p>DR3-DQ2 &amp;<br>
      DR4-DQ8</p></td>
   <td>
    <ul>
     <li>Highest risk of autoimmune T1D</li>
     <li>DR3-DQ2 is also strongly associated with celiac disease</li>
     <li>DR3-DQ2 expression is also reported in members of family with autoimmune thyroid disease and autoimmune T1D</li>
    </ul></td>
   <td>
    <ul>
     <li>By the age of 15 years, 5% of individuals with this genotype expression develop autoimmune T1D</li>
    </ul></td>
  </tr>
  <tr>
   <td>
    <p><em>MHC class I chain related gene A</em></p>
    <p>Polymorphism of MIC-A (especially alleles 5 and 5.1)</p></td>
   <td>
    <ul>
     <li>Strongly associated with T1D and celiac disease (alleles 4 and 5.1)</li>
    </ul></td>
   <td>
    <ul>
     <li>Homozygous MIC-A 5.1 allele expression along with positivity for 21-OH enzyme is known to predispose individuals with autoimmune T1D to Addison’s disease</li>
    </ul></td>
  </tr>
  <tr>
   <td>
    <p>Polymorphism of PTPN22 gene, encoding LYP</p></td>
   <td>
    <ul>
     <li>Associated with autoimmune T1D, Grave’s disease, rheumatoid arthritis, systemic lupus erythematosus and Addison’s disease</li>
    </ul></td>
   <td>
    <ul>
     <li>NA</li>
    </ul></td>
  </tr>
  <tr>
   <td>
    <p>CTLA-4</p></td>
   <td>
    <ul>
     <li>Linked to&nbsp;autoimmune thyroid disease&nbsp;and Addison’s disease</li>
    </ul></td>
   <td>
    <ul>
     <li>More strongly linked to patients affected with Addison’s disease in association with autoimmune T1D and autoimmune thyroid disease vs Addison’s disease alone</li>
    </ul></td>
  </tr>
 </tbody>
</table>
<p data-font="small">21-OH; 21-hydroxylase; AITD autoimmune thyroid disease; CTLA-4, cytotoxic T lymphocyte-associated antigen-4; HLA, human leukocyte antigen; LYP, lymphoid tyrosine phosphatase; MIC-A, MHC-I related gene; T1D, type 1 diabetes</p>

<h2 id="guidelines">ADA guideline recommendations for screening of autoimmune diseases in autoimmune T1D</h2>
<p>Individuals with an existing autoimmune disease are more prone to develop other associated autoimmune diseases.<sup>4-6,10</sup></p>
<p>The&nbsp;<a href="https://diabetesjournals.org/care/article/47/Supplement_1/S52/153956/4-Comprehensive-Medical-Evaluation-and-Assessment" rel="noreferrer" target="_blank">2024 ADA guidelines on Comprehensive Medical Evaluation and Assessment of Comorbidities</a>&nbsp;recommend screening for autoimmune thyroid disease soon after a T1D diagnosis and periodically, thereafter. Additionally, screening for celiac disease is recommended in the presence of gastrointestinal symptoms, signs, laboratory manifestations, or suspicion of celiac disease.<sup>10</sup></p>

<h3>Test for autoantibodies!</h3>
<p>Screening for autoantibodies to identify individuals at risk for autoimmune T1D.</p>

<h3>Screening for autoimmune T1D should be advised in individuals with other associated autoimmune diseases, given their higher risk than general population<sup>4‑6</sup></h3>

Individuals living with other associated autoimmune diseases like celiac disease or autoimmune thyroid disease, are at an increased risk of developing autoimmune type 1 diabetes (T1D) and should be appropriately screened.<sup>1-6</sup>

Does your patient have an existing autoimmune condition? Check for autoimmune type 1 diabetes!

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When a Child Gets Autoimmune Type 1 Diabetes

Sleep and QOL: the full impact on patients coping with the burden of AD

Does your patient have an existing autoimmune condition? Check for autoimmune type 1 diabetes!

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