Аутоиммунные заболевания эфиопского и неэфиопского типа 1 Пациенты диабета в Израиле.

Introduction

Up to 40% of type 1 diabetes (T1D) patients develop additional AIDs, with the most frequently encountered being autoimmune thyroid disease (AIT) (15–30%), celiac disease (CD) (4–9%), autoimmune gastritis (0.3–0.5%), and Addison’s disease (0.5%) 1 , 2 . The autoimmune-mediated clustering of two or more endocrine and non-endocrine diseases, known as polyglandular autoimmune syndromes, is also commonly observed in T1D. AIDs may appear before, simultaneously with, or after the onset of T1D.

In Israel, AID screening in T1D follows the American Diabetes Association (ADA) guidelines 3 , 4 . They advise measuring TSH at diagnosis, adding thyroid autoantibodies when indicated, and repeating thyroid testing over time with closer follow-up when autoantibodies are present. Similarly, they recommend serologic screening for CD at diagnosis or when symptoms suggest it, with further testing guided by clinical judgment. For vitamin B12 deficiency and autoimmune gastritis, international guidelines support measuring serum B12 only when symptoms or laboratory findings raise concern, and routine antiparietal cell antibody screening is not recommended in asymptomatic individuals. Consequently, these evaluations are performed selectively rather than universally. For other autoimmune conditions, no specific screening recommendations exist beyond symptom-based assessment.

Since the 1980s, several waves of immigration from Ethiopia have occurred. As of the end of 2023, the Ethiopian Jewish population in Israel was estimated at approximately 171,000 individuals, comprising less than 2% of the total Israeli population, according to data from the Israeli Central Bureau of Statistics 5 .

The prevalence of T1D among the Ethiopian Jewish population has increased markedly since the 1980s, rising from approximately 0.4% to levels substantially higher than those observed in the general Israeli population. This trend is thought to reflect an interaction between underlying genetic susceptibility and prolonged exposure to diabetogenic environmental influences encountered after immigration, including dietary transitions, urbanization, and socioeconomic factors 6 – 8 . Additionally, individuals of Ethiopian Jewish descent exhibit a distinct human leukocyte antigen (HLA) profile, characterized by unique frequencies of T1D-associated alleles and haplotypes. Benedek et al. investigated several ethnic groups in Israel and identified significant variability in the distribution of T1D-linked HLA markers among Ethiopian Jewish patients, suggesting a different immunogenetic susceptibility pattern in this population 9 .

Despite the known variability in AIDs prevalence and expression across ethnic groups, current clinical guidelines for screening and management of coexisting AIDs in individuals with T1D do not incorporate ethnic-specific considerations. This largely stems from a lack of robust, population-based data on non-European populations, as most research to date has been conducted in European and North American cohorts 1 , 10 – 13 . Consequently, guidelines may not adequately reflect the risk profiles or clinical needs of ethnic minorities, particularly in regions where healthcare resources and demographic patterns differ significantly.

In particular, limited attention has been paid to the prevalence of multiple coexisting AIDs in adult patients with T1D outside of Western contexts. The current literature has primarily focused on AIT and CD, with minimal investigation into the broader spectrum of autoimmune conditions 11 , 14 , 15 . Importantly, existing data on other AIDs, such as antiphospholipid antibodies (APLA) and rheumatic diseases, suggest that ethnic background significantly influences both disease incidence and phenotype 16 , 17 .

Our earlier work showed distinct risk profiles for diabetes-related complications in Ethiopian versus non-Ethiopian individuals with T1D. Ethiopian patients had a 30% higher likelihood of microvascular complications but a 40% lower risk of macrovascular complications. These contrasting patterns suggest that the prevalence and spectrum of other comorbidities, particularly AIDs, may also differ. Investigating this possibility is essential for optimizing screening and clinical management in this population 18 .

To address this critical knowledge gap, our study aimed to comprehensively assess the prevalence and patterns of coexisting AIDs among adults with T1D in the Ethiopian population. By characterizing these patterns in an underrepresented ethnic group, our findings offer novel insights that could inform more inclusive screening strategies and contribute to the refinement of international guidelines to better accommodate ethnic diversity.

Methods

This was a retrospective cohort study of patients with T1D registered in Clalit Health Services (CHS). CHS is a primary healthcare service that captures information of approximately 5.3 million individuals (53% of the population) in Israel. CHS includes data from the common primary care electronic medical records (demographics, diagnoses, clinical variables, prescriptions, referrals, and laboratory results). It also includes medications dispensed in pharmacy offices and incorporates data from hospital discharges.

The index time for inclusion was the first diagnosis of T1D. All patients considered to have T1D according to the study criteria between 1.1.2000 and 31.12.2022 were included in the analysis if the age at diagnosis was 18 or older. Patients who were diagnosed before the age of 18 years, were included in the analysis if they had reached 18 years of age or older by December 31, 2022. Since a diagnosis of T1D is not specifically recorded, T1D was defined as one of the following criteria (Fig.  1 ):

Flow chart depicting study criteria for inclusion.

Patients at any age with positive autoantibodies, including Glutamic acid decarboxylase (anti-GAD) and/or anti-islet cell antibodies, or a decreased C-peptide with a blood level of below 0.2 nmol/L or equivalent results six months before until one year after a diabetes diagnosis, OR.

Patients diagnosed with diabetes at the age of < 18 years and more than two purchases of any fast-acting insulin (Actrapid, or Apidra (Glulisine), or Humalog (Lispro), or Novorapid (Aspart) six months before until one year after a diabetes diagnosis, OR.

Patients diagnosed with diabetes between 18 and 40 years and more than three purchases of fast-acting insulin (as above), six months before until one year after a diabetes diagnosis.

The following exclusion criteria were applied based on ICD-10 codes: (1) a diagnosis of gestational diabetes; (2) cases of neonatal diabetes mellitus; and (3) diabetes secondary to an underlying condition, including post-pancreatectomy diabetes mellitus, pancreatitis, postprocedural diabetes mellitus, and other pancreatic diseases.

Insulin autoantibodies (IAA) were not included in the analysis as we could not verify the timeline of insulin exposure to IAA measurement. Zinc-8 transporter antibodies were not considered as they were not available during the study period.

Data collected for the present analysis included age, age at diagnosis of T1D, gender, and duration of diabetes. All ICD-10 codes used for this study are specified in Supplementary Table 1. All AIDs were included, regardless of whether their onset occurred before, concurrently with, or following T1D diagnosis. We additionally extracted data on thyroid peroxidase TPO and TTG antibodies. According to medical records, we could not obtain information on anti-thyroglobulin antibodies. Additionally, we did not consider the recording of vitiligo diagnosis to be reliable; therefore, this condition was not included in the overall analysis.

Individuals were classified as being of Ethiopian ethnicity if Ethiopia was recorded as the country of birth for either the individual or one of their parents.

Ethical considerations

The study was approved by CHS institutional review board and the local Institutional Review Board (0123-23-KMC) with a waiver of informed consent due to the retrospective use of de-identified clinical data. All procedures were conducted in accordance with the Declaration of Helsinki and relevant regulations.

Statistical analysis

Categorical and nominal variables were reported as frequencies and percentages, and continuous variables were reported as means and standard deviations. Continuous variables were assessed for normality using the Shapiro-Wilk test. Comparisons between continuous variables were performed using the independent samples t-test for normally distributed data and the Mann-Whitney U test for non-normally distributed data. Associations between categorical and nominal variables were analyzed using Pearson’s chi-square (χ²) test or Fisher’s exact test, as appropriate. Statistical significance was determined at a two-tailed P-value of less than 0.05. All statistical analyses were executed using IBM SPSS Statistics for Windows, version 29.0.

Results

Study cohort characteristics

The cohort consisted of 12,759 patients with T1D, of whom 672 (5.3%) were of Ethiopian descent. The mean age was 30.4 ± 18.9 years, and 54% were male. 4,375 (34%) T1D patients were diagnosed before the age of 18 years. Mean follow-up was 10.9 ± 6.1 years. Of the entire cohort, 3,204 (25%) had additional AIDs; of them, 2,588 (20%) had one, 532 (4%) had two, and 114 (0.9%) had three or more AIDs (Table  1 ). Individuals of Ethiopian descent were significantly less likely to have a concomitant diagnosis of an additional AID compared to individuals of non-Ethiopian ethnicity (14% vs. 26%, p  < 0.001). Notably, although the prevalence of coexisting autoimmune conditions was approximately half in the Ethiopian group, the relative distribution pattern of common and less common AIDs remained similar to that observed in the non-Ethiopian population. The most common AIDs in the Ethiopian population were AIT (10%), CD (2%), and psoriasis (3%). There was no statistically significant difference in the distribution of the number of AIDs between those T1D patients diagnosed with antibody-positive and those diagnosed with decreased c-peptide level in the Ethiopian and non-Ethiopian cohorts (data not shown).

Table 1 Prevalent autoimmune diseases in type 1 diabetes patients: overall and stratified by non-Ethiopian versus Ethiopian ethnicity. Characteristics Total ( n  = 12,759) Non-Ethiopian ( n  = 12,087) Ethiopian ( n  = 672) P value* Age at diagnosis of T1D, mean ± SD 30.4 ± 18.9 30.5 ± 19.0 29.0 ± 17.3 0.083 Males, n (%) 6,835 (54) 6,437 (53) 398 (59)
0.003
T1D and additional AID, n (%) 3,203 (25) 3,106 (26) 97 (14)
< 0.001
T1D and one additional AID, n (%) 2,558 (20) 2,482 (21) 76 (11)
< 0.001
T1D and two additional AIDs, n (%) 531 (4) 510 (4) 21 (3) 0.167 T1D and three or more AIDs, n (%) 114 (0.9) 114 (0.9) 0 (0) - Thyroiditis autoimmune, n (%) 1,674 (13) 1,628 (13) 46 (7)
< 0.001
Grave’s disease, n (%) 464 (4) 440 (4) 24 (4) 0.926 Primary adrenocortical insufficiency, n (%) 24 (0.2) 24 (0.2) 0 (0) 0.248 Primary ovarian insufficiency, n (%) 42 (0.3) 37 (0.3) 5 (0.7) 0.054 Multiple sclerosis, n (%) 27 (0.2) 27 (0.2) 0 (0) 0.220 Myasthenia gravis, n (%) 26 (0.2) 26 (0.2) 0 (0) - Celiac disease, n (%) 480 (4) 470 (4) 10 (2)
0.001
Crohn’s disease, n (%) 144 (1) 141 (1) 3 (0.4) 0.085 Ulcerative colitis, n (%) 73 (0.6) 71 (1) 2 (0.3) 0.332 Atrophic gastritis, n (%) 53 (0.4) 52 (0.4) 1 (0.1) 0.290 Pernicious anemia, n (%) 17 (0.1) 17 (0.1) 0 (0) - Autoimmune hepatitis, n (%) 21 (0.2) 19 (0.2) 2 (0.3) - Psoriasis, n (%) 657 (5) 638 (5) 19 (3)
0.048
Rheumatoid arthritis, n (%) 150 (1.2) 149 (1.2) 1 (0.1) - Systemic lupus erythematosus, n (%) 40 (0.3) 38 (0.3) 2 (0.3) - Sjogren’s syndrome, n (%) 38 (0.3) 37 (0.3) 1 (0.1) - Immune thrombocytopenic purpura, n (%) 52 (0.4) 50 (0.4) 2 (0.3) - T1D: Type 1 diabetes; SD: Standard deviation; AID: Autoimmune disease. *Patients non-Ethiopian vs. Ethiopian; *P-value is significant at < 0.05.

Prevalent autoimmune diseases in type 1 diabetes patients: overall and stratified by non-Ethiopian versus Ethiopian ethnicity.

T1D: Type 1 diabetes; SD: Standard deviation; AID: Autoimmune disease.

*Patients non-Ethiopian vs. Ethiopian; *P-value is significant at < 0.05.

Timing and age of onset of the most common additional AIDs

In both cohorts, the majority of thyroiditis autoimmune, Graves’ disease (GD), and CD were diagnosed following T1D onset: 72% of thyroiditis autoimmune, 62% of GD, and 80% of CD cases were diagnosed in the Ethiopian cohort following T1D onset, compared with 64%, 66%, and 77%, in the non-Ethiopian cohort. The mean age at onset of AIT diseases and CD was also similar between the groups. The mean age at diagnosis of thyroiditis autoimmune was 36.6 ± 19.1 years, GD 42.1 ± 18.9 years, and CD 16.1 + 14.1 years. Among non-Ethiopian patients, the mean time from T1D onset to diagnosis of thyroiditis autoimmune, GD, and CD was 5.6, 6.2, and 2.9 years, respectively. In Ethiopian patients, the corresponding intervals were 6.4 years for AIT, 6.2 years for GD, and 2.5 years for CD.

Autoimmune disease development stratified according to country of birth

By country of birth, the majority of Ethiopian Jews were immigrants born in Ethiopia ( n  = 421, 63%), and the rest were born in Israel ( n  = 251, 37%); most of the latter were first-generation Ethiopian immigrants. GD occurred more frequently among immigrants (5% vs. 1%, p  = 0.011), while Ethiopians born in Israel had a higher prevalence of CD (4% vs. 0.2%, p  = 0.003) (Table  2 ).

Table 2 Prevalence of autoimmune disease in Ethiopian immigrants and Ethiopians born in Israel. Characteristics Total Ethiopian ( n  = 672) Born in Israel ( n  = 251) Immigrants ( n  = 421) * P value Males, n (%) 138 (55) 260 (62) 0.084 T1D and additional AID, n (%) 30 (12) 67 (16) 0.193 T1D and one additional AID, n (%) 25 (10) 51 (12) 0.467 T1D and two additional AIDs, n (%) 5 (2) 16 (4) 0.283 Thyroiditis autoimmune, n (%) 14 (6) 32 (8) 0.320 Grave’s disease, n (%) 3 (1) 21 (5)
0.011
Primary ovarian insufficiency, n (%) 0 (0) 5 (1) - Celiac disease, n (%) 9 (4) 1 (0.2)
0.003
Crohn’s disease, n (%) 0 (0) 3 (0.7) - Ulcerative colitis, n (%) 1 (0.4) 1 (0.2) - Atrophic gastritis, n (%) 0 (0) 1 (0.2) - Autoimmune hepatitis, n (%) 1 (0.4) 1 (0.2) - Psoriasis, n (%) 7 (3) 12 (3) 1.000 Rheumatoid arthritis, n (%) 0 (0) 1 (0.2) - Systemic lupus erythematosus, n (%) 0 (0) 2 (0.5) - Sjogren’s syndrome, n (%) 0 (0) 1 (0.2) - Immune thrombocytopenic purpura, n (%) 0 (0) 2 (0.5) - T1D: Type 1 diabetes; SD: Standard deviation; AID: Autoimmune disease. *Patients Born in Israel vs. Immigrants Ethiopian; *P-value is significant at < 0.05.

Prevalence of autoimmune disease in Ethiopian immigrants and Ethiopians born in Israel.

T1D: Type 1 diabetes; SD: Standard deviation; AID: Autoimmune disease.

*Patients Born in Israel vs. Immigrants Ethiopian; *P-value is significant at < 0.05.

Antibodies screening practices

We examined whether differences in routine screening practices caused the lower rates of AIDs prevalence among the Ethiopian population. We used anti-TPO and anti-TTG tests as markers of testing frequency. As seen in Table  3 , there were no notable differences in screening practices between the two populations. Fewer than 50% of patients underwent testing for TPO antibodies at least once. Among those diagnosed with thyroiditis autoimmune, TPO antibody testing was performed in 72% of cases in both groups, and test results supported the diagnosis thyroiditis autoimmune. Screening for CD was documented in approximately half of the study cohort and nearly all patients with CD. Notably, among 470 non-Ethiopian T1D patients with CD, 458 (97%) had diagnostic test results consistent with the diagnosis, while all 10 Ethiopian patients had positive confirmatory tests.

Table 3 Rates of anti-TPO and anti-TTG autoantibodies testing in the study cohort. Characteristics Non-Ethiopian Ethiopian Total N  = 12,087 N  = 672 Number (count) of TPO antibody tests: Not performed 6,857 (57) 407 (61) 1–3 3,835 (32) 197 (29) 4–6 861 (7) 48 (7) 7–10 357 (3) 16 (2) >10 177 (1) 4 (1) Thyroiditis autoimmune N  = 1,628 N  = 46 Number of TPO antibody tests in patients with autoimmune thyroiditis: Not performed 452 (28) 13 (28) ≥1 1,176 (72) 33 (72) Number of TTG antibody tests: Not performed 5,830 (48) 337 (50) 1–3 4,153 (34) 225 (33) 4–6 1,227 (10) 71 (11) 7–10 585 (5) 30 (4) >10 292 (2) 9 (1) Celiac disease N  = 470 N  = 10 Number of TTG antibody tests in patients with celiac disease: Not performed 9 (2) 0 (0) ≥1 461 (98) 10 (100) TPO: Thyroid peroxidase; TTG: Tissue transglutaminase.

Rates of anti-TPO and anti-TTG autoantibodies testing in the study cohort.

TPO: Thyroid peroxidase; TTG: Tissue transglutaminase.

Discussion

In this cohort study of Ethiopian ancestry with T1D, we found a lower prevalence of AIDs compared with non-Ethiopian T1D patients, a difference that was not driven by a single condition but rather reflected a consistent pattern across both common and less common autoimmune diseases. Notably, although the prevalence of coexisting AIDs was approximately half in Ethiopians, the relative distribution pattern of common and less common AIDs remained similar to that observed in the non-Ethiopian population.

Studies on other AIDs, such as multiple sclerosis or APLA, have previously shown differences in prevalence and clinical characteristics among diverse ethnic groups 19 , 20 . They suggest that lower diagnosis rates stem from underutilization of medical services or under-recognition of AIDs-related features, among the diverse Israeli ethnic population 20 . Additionally, ethnic differences in susceptibility to AIDs likely reflect a complex interplay of genetic and environmental factors; hence, further studies on genetics, environmental exposures, and social factors related to health services provision and utilization related to AIDs are potential areas for further study.

Similar to previous observations in T1D patients, AIT was the most frequently detected autoimmune condition among Ethiopian patients, followed by CD 11 – 14 .

We found a very limited number of reported cases of CD in the Ethiopian population, and no studies specifically addressing CD in Ethiopians with T1D 21 – 23 . Gudeta et al. investigated a cohort of 1,193 children from the Oromia regional state in Ethiopia and compared them with 2,000 randomly selected children from the general population in Sweden to assess the prevalence of HLA-DQ risk haplotypes associated with CD. Their findings revealed that the frequency of these HLA risk haplotypes was remarkably similar between Ethiopian and Swedish children 21 .

The same group conducted a study involving 1,942 pregnant women with a median age of 25 years from 14 health centers in Central and South-East Oromia to determine the prevalence of CD autoimmunity during pregnancy. The study found a TTG test positivity rate of 0.05% 22 . In comparison, the prevalence of TTG autoantibody positivity was 0.6% during the screening of Ethiopian children up to four years, with a corresponding incidence rate of 1.2 cases per 1,000 person-years 23 . They concluded that the rate of CD autoimmunity positivity in Ethiopia is lower than the pooled global seroprevalence of CD antibody, which varied from 1.1% (Africa) to 1.4% (Oceania and North America), but corresponded to the prevalence of CD reported from Egypt (0.5%), and Western Europe (0.6%) 22 – 25 .

Our study showed that the prevalence of CD was half among Ethiopian patients compared with non-Ethiopian patients (2% vs. 4%, p = 0.001, respectively). However, when stratifying the data according to country of birth among the Ethiopian patients, we found that the majority of cases were diagnosed among Isreali born. This likely reflects either underdiagnosis in immigrant populations or an altered nutritional choice. It may be speculated that Israeli-born Ethiopians tend to consume local Israeli diets rather than traditional Ethiopian foods (“injera,” a flat sour-like fermented bread from teff that has no gluten or gluten peptides, the traditional food of the Ethiopian people) 26 . This necessitates increased awareness by local physicians.

Interestingly, certain AIDs such as multiple sclerosis, myasthenia gravis, Addison’s disease, and pernicious anemia were not detected in the Ethiopian T1D population. This finding may be explained by a lower predisposition to these AIDs. Supporting this, a report from Ethiopia indicates that multiple sclerosis is a rare diagnosis with an estimated prevalence of 1–5/100,000 people 27 . However, the rarity of diagnoses for some AIDs, including Addison’s disease and pernicious anemia, could also reflect under-recognition rather than true absence. On the other hand, the tendency toward the development of primary ovarian insufficiency is an important finding that warrants the attention of endocrinology and gynecology physicians and further research in this population.

Not related to T1D, data from Ethiopia indicate that overall AIDs are uncommon 28 . A report encompassing 7,966 patients from four different hospitals in Addis Ababa, identified 19 cases of RA, (0.2%); GD, 15 (0.18%); Systemic lupus erythematosus, 4 (0.05%); Immune thrombocytopenia, 2 (0.02%); direct Coomb’s positive hemolytic anemia, 2 (0.02%); dermatomyositis, 1 (0.01%); myasthenia gravis, 1 (0.01%). There was no proven case of Hashimoto’s disease, Ulcerative colitis, pernicious anemia, Sjögren’s syndrome, or polyarteritis nodosa 28 .

The combination of multiple AIDs in T1D patients is a well-established phenomenon. In our Ethiopian cohort, 3% of patients had two additional AIDs, a rate very similar to the non-Ethiopian cohort. However, none of the Ethiopian patients had more than two additional AIDs, whereas approximately 1% of the non-Ethiopian cohort had three or more. Most of these autoimmune combinations involved AIT disorders (16 cases of 21 cases), highlighting the importance of increased clinical attention to T1D Ethiopian patients with thyroid disease.

Current ADA guidelines for adult screening in T1D recommend screening for AIT at diagnosis and repeated intervals if clinically indicated, and for CD in the presence of gastrointestinal symptoms, laboratory manifestations, or clinical suspicion suggestive of CD 4 . Screening for other AIDs should be considered if clinically indicated. Children and adolescents should be screened for anti-TPO, anti-thyroglobulin, and anti-TTG, soon after diagnosis and at prespecified intervals 4 .

Notably, approximately half of the patients were not tested for autoantibodies presence. However, testing rates were comparable between the two ethnicities, highlighting that the lower prevalence of AIDs does not stem from lower screening rates. This variability in screening likely reflects real-world clinical practices, where the absence of clear, universally applied guidelines for autoimmune screening in T1D contributes to inconsistent testing. To improve adherence, strategies should include implementing standardized screening protocols, incorporating routine antibody testing for selected conditions in high-risk patients, enhancing physician awareness of less common autoimmune diseases, and removing logistic barriers for their implementation.

The main strengths of this study are the large cohort of well-characterized patients with T1D and the possibility to identify AIDs during a long follow-up period. We also examined autoantibodies screening rates for both thyroid and CD in an attempt to rule out the possibility that the lower prevalence was caused by lower screening rates. As the existing literature is scarce, to our knowledge, to date, this is the first study that provides comprehensive data on additional AIDs in a cohort of Ethiopian patients with T1D.

Yet, our study is not without limitations. First, the study is retrospective, and some data for the examined variables are missing. Additionally, data does not contain information regarding environmental factors, including lifestyle and dietary habits. We also cannot exclude the possibility of underreporting AIDs. Moreover, our dataset does not include information on the duration of residence in Israel among Ethiopian emigrants prior to enrollment, which may influence environmental exposure and disease risk profiles. Lastly, in the lack of a specific code for T1D, a set of criteria meant to capture T1D patients was used. However, the possibility that some patients were misclassified cannot be ruled out.

In conclusion, in our study, we demonstrated for the first time a lower rate of AIDs prevalence among people of Ethiopian ethnicity with T1D. Importantly, the comparable screening rates between groups suggest that the observed differences in prevalence are unlikely to result from underdiagnosis alone. Despite the lower overall prevalence, the relative pattern of common and less common autoimmune conditions remained similar between the two groups, fulfilling our secondary objective of characterizing the distribution of AIDs within the Ethiopian T1D population. Our findings highlight the importance of considering ethnic background when evaluating autoimmune comorbidities in T1D, including the potential roles of genetic, environmental, and healthcare-related factors. Further prospective and mechanistic studies are needed to elucidate the underlying biological and sociocultural drivers of these ethnic disparities. Future clinical guidelines may benefit from integrating ethnic-specific considerations when formulating screening and management recommendations for autoimmune comorbidities in T1D. .

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1

Acknowledgements

We thank Merav Greenstein, Tamar Zohar and Amit Davidpur for their valuable help during the study.

Abbreviations

Autoimmune disease

Antiphospholipid antibodies

Autoimmune thyroid disease

Clalit Health Services

Celiac disease

Glutamic acid decarboxylase

Grave’s disease

Insulin autoantibodies

Standard deviation

Tissue transglutaminase

Thyroid peroxidase

Type 1 diabetes

Author contributions

AK: Conceptualization, methodology, investigation, visualization, supervision and writing original draft. AB: Methodology, investigation, visualization, review & editing, supervision. HG: Methodology, investigation, visualization, review & editing. HAK: Methodology, investigation and visualization. MA: Investigation and visualization. MZD: Investigation and visualization. RC: Investigation and visualization. TS: Conceptualization, methodology, investigation, visualization, supervision, and writing original draft.

Funding

This study was supported by a grant from the Russell Berrie Galilee Diabetes Sphere of the Azrieli Faculty of Medicine Br-Ilan University (AK, AB & TS; SPCL2023003).

Data availability

The corresponding author Alena Kirzhner will provide the research data upon a reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

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References

Associated Data

Supplementary Materials

Supplementary Material 1

Data Availability Statement

The corresponding author Alena Kirzhner will provide the research data upon a reasonable request.