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data were collected from 242 departments in germany / austria by means of a computerized follow - up program called the diabetes prospective documentation initiative ( diabetes patienten verlaufsdokumentation [ dpv ] ) ( 4 ) . data from 46,342 patients between 1990 and 2008 were included in the database .
we analyzed 28,671 patients ( mean age 13.7 years ; range 030 ; 52.2% male ) with at least one autoantibody measurement ( gada , ica , iaa , and ia-2a at onset ; tg , tpo , gliadin - ab , tga , pca , and aa - ab ) .
patients were divided into age - groups according to developmental stage : age - group 1 ( 0.112 years ; n = 9,431 ) , age - group 2 ( 1218 years ; n = 15,495 ) , and age - group 3 ( 1830 years ; n = 3,745 ) .
data were analyzed using the sas statistical software package , version 9.1 ( sas institute , cary , nc ) .
data are presented as mean  sd for normal distributed variables or median and range for non - gaussian distributed parameters . for group comparisons , nonparametric statistical tests ( kruskall - wallis test ) were used , with adjustment for multiple comparisons ( method of holm ) .
data were collected from 242 departments in germany / austria by means of a computerized follow - up program called the diabetes prospective documentation initiative ( diabetes patienten verlaufsdokumentation [ dpv ] ) ( 4 ) .
we analyzed 28,671 patients ( mean age 13.7 years ; range 030 ; 52.2% male ) with at least one autoantibody measurement ( gada , ica , iaa , and ia-2a at onset ; tg , tpo , gliadin - ab , tga , pca , and aa - ab ) .
patients were divided into age - groups according to developmental stage : age - group 1 ( 0.112 years ; n = 9,431 ) , age - group 2 ( 1218 years ; n = 15,495 ) , and age - group 3 ( 1830 years ; n = 3,745 ) .
data were analyzed using the sas statistical software package , version 9.1 ( sas institute , cary , nc ) .
data are presented as mean  sd for normal distributed variables or median and range for non - gaussian distributed parameters . for group comparisons , nonparametric statistical tests ( kruskall - wallis test ) were used , with adjustment for multiple comparisons ( method of holm ) .
thyroid autoantibodies were screened in 87.3% of patients , followed by celiac disease antibody ( 75.7% ) , tga ( 49.9% ) , -cell  ab ( 52.6% ) , aa - ab ( 10.0% ) , and pca ( 6.3% ) ; all listed in table 1 . screening frequency and number of patients with positive autoantibodies ( in parentheses ) in 28,671 patients with type 1 diabetes ( divided into three age - groups ) from the german - austrian dpv - wiss cohort * data are n ( % positive ) ( n refers to the number of patients with at least one autoantibody determination ) .
cd - ab includes autoantibodies against gliadin ( iga/ igg ) and anti - tissue transglutaminase .
at least one -cell  ab ( ica , gad , ia2 , iaa ) was present in 12,070 of 14,784 patients ( 81.6% ) .
gadas were most frequently measured ( n = 11,150 , 65.3% positive ) , followed by icas ( n = 10,515 , 58.3% positive ) , iaas ( n = 8,468 , 67.6% positive ) , and ia-2as ( n = 7,488 , 66.1% positive ) .
ab - negative patients were significantly younger at type 1 diabetes onset ( 8.4  4.7 vs. 9.1  4.5 years , p < 0.0001 ) .
a total of 4,901 patients ( 19.6% ) were found to have elevated titers of at least one thyroid ab .
thyroid autoimmunity was associated to female sex ( 62 vs. 44% in thyroid - ab  negative patients , p < 0.0001 ) , older age ( 15.3  3.8 vs. 13.4  4.6 years ) , and longer duration of diabetes ( 6.7  4.5 vs. 5.3  4.1 years ; both p < 0.0001 ) .
tgas were measured in 14,301 patients , with a positive result in 10.7% ( n = 1,529 ) .
tga - positive patients showed a significantly longer duration of diabetes ( 5.6  3.9 vs. 5.0  3.9 years , p < 0.0001 ) .
pcas were investigated in 1,795 patients ( 6.3% ) , with a positive result in 283 subjects ( 15.8% ) , associated with older age ( 15.8  4.7 vs. 14.3  4.6 years , p < 0.001 ) and longer duration of diabetes ( 8.3 vs. 6.1 years , p < 0.0001 ) .
screening for aa - ab was performed in 2,877 patients ( 10.0% ) , with a positive result in 94 patients ( 3.3% ) .
patients with -cell autoimmunity showed a significantly higher prevalence of aa - ab compared with -cell  ab - negative patients ( 3.7 vs. 1.5% , p < 0.05 ) . in 575 patients ( 60% female , mean age 14.4 years ) , at least three different autoimmune phenomena were present ( most prevalent : -cell  ab , n = 565 ; tpo , n = 378 ) .
thyroid autoantibodies were screened in 87.3% of patients , followed by celiac disease antibody ( 75.7% ) , tga ( 49.9% ) , -cell  ab ( 52.6% ) , aa - ab ( 10.0% ) , and pca ( 6.3% ) ; all listed in table 1 . screening frequency and number of patients with positive autoantibodies ( in parentheses ) in 28,671 patients with type 1 diabetes ( divided into three age - groups ) from the german - austrian dpv - wiss cohort * data are n ( % positive ) ( n refers to the number of patients with at least one autoantibody determination ) .
cd - ab includes autoantibodies against gliadin ( iga/ igg ) and anti - tissue transglutaminase .
at least one -cell  ab ( ica , gad , ia2 , iaa ) was present in 12,070 of 14,784 patients ( 81.6% ) .
gadas were most frequently measured ( n = 11,150 , 65.3% positive ) , followed by icas ( n = 10,515 , 58.3% positive ) , iaas ( n = 8,468 , 67.6% positive ) , and ia-2as ( n = 7,488 , 66.1% positive ) .
ab - negative patients were significantly younger at type 1 diabetes onset ( 8.4  4.7 vs. 9.1  4.5 years , p < 0.0001 ) .
a total of 4,901 patients ( 19.6% ) were found to have elevated titers of at least one thyroid ab .
thyroid autoimmunity was associated to female sex ( 62 vs. 44% in thyroid - ab  negative patients , p < 0.0001 ) , older age ( 15.3  3.8 vs. 13.4  4.6 years ) , and longer duration of diabetes ( 6.7  4.5 vs. 5.3  4.1 years ; both p < 0.0001 ) .
tgas were measured in 14,301 patients , with a positive result in 10.7% ( n = 1,529 ) .
tga - positive patients showed a significantly longer duration of diabetes ( 5.6  3.9 vs. 5.0  3.9 years , p < 0.0001 ) .
pcas were investigated in 1,795 patients ( 6.3% ) , with a positive result in 283 subjects ( 15.8% ) , associated with older age ( 15.8  4.7 vs. 14.3  4.6 years , p < 0.001 ) and longer duration of diabetes ( 8.3 vs. 6.1 years , p < 0.0001 ) .
screening for aa - ab was performed in 2,877 patients ( 10.0% ) , with a positive result in 94 patients ( 3.3% ) .
patients with -cell autoimmunity showed a significantly higher prevalence of aa - ab compared with -cell  ab - negative patients ( 3.7 vs. 1.5% , p < 0.05 ) .
in 575 patients ( 60% female , mean age 14.4 years ) , at least three different autoimmune phenomena were present ( most prevalent : -cell  ab , n = 565 ; tpo , n = 378 ) .
we present the results of a large patient group based on the dpv documentation system .
this involved the participation of 242 diabetes centers , 28,671 documented patients , and an observation period 10 years .
as previously shown , -cell antibodies were present in 80% of patients diagnosed with type 1 diabetes ( 5 ) .
the observation that -cell  ab - negative subjects were younger is not consistent with previous findings , suggesting -cell  ab - negative diabetes forms at an older age in a cohort of patients < 18 years , but this might have been also patients with clinical type 2 diabetes ( 6 ) .
our data support previous studies documenting the high prevalence of thyroid autoimmunity in young patients with type 1 diabetes ( 7 ) and their association to female sex and older age ( 8) .
we can show an association between autoimmunity suggestive of celiac disease and a longer duration of type 1 diabetes .
the hypothesis of type 1 diabetes as the first autoimmune disease , followed by celiac disease ( 9,10 ) , is confirmed and emphasizes the need for repeated antibody testing for celiac disease .
pcas are characteristic for autoimmune gastritis and are directed to the h+,k+-atpase of parietal cells .
this is the first study to investigate pcas in a large cohort of young patients with type 1 diabetes .
the prevalence of pcas increased with age and longer duration of type 1 diabetes . in a study of adults with type 1 diabetes , de block et al . ( 11 ) reported a prevalence of 20.9% of patients with pca , with iron deficiency anemia in 15.4% and pernicious anemia in 10.5% .
( 12 ) studied aa - ab in patients with type 1 diabetes in 2005 with a positive result in 1.4% . in previous studies , the development of addison 's disease in patients with aa - ab varies between 18 and 45% ( 13,14 ) .
unfortunately , we do not have data on the reasons for pca and aa - ab testing , nor do we know about clinical outcome .
thus , the unexpected high number of positive patients may be due to selection factors such as underlying disorders , or even cost factors .
further studies on prevalence of pca and aa - ab in type 1 diabetes and associated clinical features are preferable . apart from a slightly higher prevalence of aa - ab in the -cell  ab - positive groups , no differences between -cell  ab - positive and -negative patients were detected .
thus , the proof of -cell autoimmunity can not be seen as a predictor of additional autoimmunity .
we are aware of the weakness of decentralized antibody testing , but centralized measurements were not practicable because of organizational / financial difficulties and the involvement of 242 centers .
all of the laboratories have taken part at a nationwide quality control circle and gave consent to international standardization workshops ( 15 ) .
objectiveto investigate diabetes - specific autoantibodies and additional autoimmune phenomena in a large cohort of young patients with type 1 diabetes.research design and methodsdata from 28,671 patients < 30 years with type 1 diabetes from 242 specialized centers in germany and austria were analyzed.resultsat least one -cell antibody was present in 81.6% of patients . 
 -cell  
 ab - negative patients were significantly younger at diabetes onset ( p < 0.0001 ) . 
 a total of 19.6% had positive thyroid antibodies with female predominance ( 62% , p < 0.0001 ) . 
 antibodies to tissue transglutaminase were present in 10.7% , with a significantly longer duration of diabetes ( p < 0.0001 ) . 
 parietal cell antibodies were found in 283 patients , associated with older age ( p < 0.001 ) , and adrenal antibodies were present in 94 patients . in 575 patients , at least three different autoimmune phenomena were present.conclusionsthyroid autoimmunity and antibodies suggestive for celiac disease are the most prevalent additional immune phenomena in type 1 diabetes . 
 parietal / adrenal antibodies are rare .