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Type 1 Diabetes and Multiple Sclerosis
A Danish Population-Based Cohort Study
Nete M. Nielsen, MSc, MD, PhD;
Tine Westergaard, MD, PhD;
Morten Frisch, MD, PhD, DMSc;
Klaus Rostgaard, MSc;
Jan Wohlfahrt, MSc, DMSc;
Nils Koch-Henriksen, MD, DMSc;
Mads Melbye, MD, DMSc;
Henrik Hjalgrim, MD, PhD
Arch Neurol. 2006;63:1001-1004.
Background Type 1 diabetes mellitus (T1D) and multiple sclerosis (MS) contribute considerably to the burden of autoimmune diseases in young adults. Although HLA patterns of T1D and MS are considered mutually exclusive, individual and familial co-occurrence of the 2 diseases has been reported.
Objective To assess the co-occurrence of T1D and MS by estimating the risk for MS in patients with T1D and the risk for T1D in first-degree relatives of patients with MS.
Design, Setting, and Participants Two population-based disease registers, the Danish Hospital Discharge Register and the Danish Multiple Sclerosis Register were used to identify patients with T1D, defined as patients in whom diabetes was diagnosed before age 20 years (N = 6078), and patients with MS (N = 11 862). First-degree relatives (N = 14 771) of patients with MS were identified from family information in the Danish Civil Registration System.
Main Outcome Measure Patients with T1D and first-degree relatives of patients with MS were followed up for occurrence of MS and T1D, respectively, and the relative risks were expressed as standardized incidence ratios, that is, ratios of observed to expected numbers of outcomes based on national age, sex, and period-specific MS and T1D incidence rates.
Results Patients with T1D were at more than 3-fold increased risk for development of MS (relative risk, 3.26; 95% confidence interval, 1.80-5.88; n = 11). First-degree relatives of patients with MS were at 63% increased risk (relative risk, 1.63; 95% confidence interval, 1.26-2.12; n = 56) for development of T1D. However, adjusting for familial relationship to patients with T1D reduced the excess risk to 44% (relative risk, 1.44; 95% confidence interval, 1.11-1.88; n = 56).
Conclusion The present nationwide cohort study demonstrates an intraindividual and, to a lesser degree, an intrafamilial co-occurrence of MS and T1D.
Author Affiliations: Department of Epidemiology Research, Statens Serum Institut, Copenhagen (Drs Nielsen, Westergaard, Frisch, Wohlfahrt, Melbye, and Hjalgrim and Mr Rostgaard); Department of Neurology, Aarhus University Hospital, Aalborg (Dr Koch-Henriksen); National Institute of Public Health, Copenhagen (Dr Koch-Henriksen), and Danish Register of Multiple Sclerosis, National University Hospital, Copenhagen (Dr Koch-Henriksen), Denmark.
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