A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

Kurien, Matthew; Mollazadegan, Kaziwe; Sanders, David S.; Ludvigsson, Jonas F.

doi:10.1007/s00592-015-0808-y

Cited by 10 publications

(7 citation statements)

References 36 publications

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“…Compared to T1D‐only patients, our data support the findings of others, that CD in T1D is not associated with a higher risk for DKA and severe hypoglycemia . The trend for higher acute complications rates in the Ab‐pos group might reflect a worse overall adherence with therapy.…”

Section: Discussionsupporting

confidence: 88%

“…Compared to T1D-only patients, our data support the findings of others, that CD in T1D is not associated with a higher risk for DKA and severe hypoglycemia. 33 The trend for higher acute complications rates in the Ab-pos group might reflect a worse overall adherence with therapy. Supporting this argumentation, a recent study on quality of life and compliance with GFD found that adolescents with T1D and CD, who were non-adherent to diet had lower well-being scores and worse glycemic control.…”

Section: Discussionmentioning

confidence: 99%

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Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

et al. 2019

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Objectives To study celiac‐specific antibody status over 3 years in patients with type 1 diabetes and biopsy‐proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody‐negativity (Ab‐neg) and staying antibody‐positive (Ab‐pos). Methods A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody‐status. Differences between Ab‐neg (n = 218) and Ab‐pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background. Results Thirty‐six percent of T1D + CD patients reached and sustained antibody‐negativity 3 years after CD diagnosis. The median time until patients returned to Ab‐neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab‐neg and highest in Ab‐pos patients compared to T1D‐only patients (adjusted mean (95%CI): 7.72 (7.51‐7.92) % vs 8.44 (8.20‐8.68) % vs 8.19 (8.17‐8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL‐cholesterol and frequency of dyslipidemia were significantly lower in Ab‐neg compared to T1D‐only patients (167 (161‐173) mg/dl vs 179 (178‐179) mg/dl, P < .001; 90 (84‐96) mg/dl vs 99 (98‐99) mg/dl, P = .005; 15.7 (10.5‐22.9) % vs 25.9 (25.2‐26.6) %, P = .017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c (P < .001) and a lower height‐SDS (P = .044) was observed in Ab‐pos compared to Ab‐neg patients. Conclusion Only one third of T1D + CD patients reached constant Ab‐negativity after CD diagnosis. Achieving Ab‐negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

et al. 2019

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“…In 124 adults with T1DM with severe and recurrent hypoglycaemia who met the criteria for islet cell transplantation, the prevalence of CD was 8%; 7 of 10 patients were newly diagnosed with CD . A nationwide Swedish study reported that the risk of diabetic ketoacidosis and hypoglycaemia was not increased in T1DM + CD; however, only subjects who required admission to hospital for hypoglycaemia were examined, with the true incidence of hypoglycaemia likely to be underestimated . Our results showing that CD is independently associated with reported hypoglycaemia, is consistent with much of the published literature, showing the need for greater vigilance in T1DM + CD.…”

Section: Discussionsupporting

confidence: 87%

Increased prevalence of fracture and hypoglycaemia in young adults with concomitant type 1 diabetes mellitus and coeliac disease

Thong

Wong

Dev

et al. 2017

Clinical Endocrinology

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Summary Background Both Type 1 diabetes mellitus (T1DM) and coeliac disease (CD) are independently associated with reduced bone mineral density (BMD) and increased fracture risk. Whilst poorer glycaemic control and increased microvascular complications have been described, the literature examining bone health and fractures in adults with concomitant T1DM and CD (T1DM + CD) is limited. Objective To evaluate fracture prevalence and explore associations with glycaemic control, hypoglycaemia and microvascular disease in T1DM + CD compared with T1DM alone. Methods We conducted a retrospective cross‐sectional study of young adults with T1DM, who attended diabetes clinics at a large tertiary referral centre between August 2016 and February 2017. Clinical information, radiological and biochemistry results were extracted from medical records. Patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism were excluded. Results A total of 346 patients with T1DM alone (median age 23 years) and 49 patients with T1DM + CD (median age 24 years) were included. Median age, gender distribution, BMI, haemoglobin A1c, daily insulin dose and serum 25‐hydroxyvitamin D levels were similar between groups. Higher adjusted fracture risk was observed in T1DM + CD compared with T1DM (12.2% vs 3.5%; OR 3.50, 95% CI 1.01‐12.12, P = .01), yet BMD was only measured in 6% of patients. The adjusted risk of hypoglycaemia ≥2/week was greater for T1DM + CD (55% vs 38%, OR 3.28, 95% CI 1.61‐6.69, P = .001); however, this was not independently associated with fractures. Replete vitamin D (≥ 50 nmol/L) was associated with less hypoglycaemia (OR 0.48, 95% CI 0.29‐0.80; P = .005), but not with fractures. Conclusions Coeliac disease status was independently associated with increased fracture prevalence in young adults with T1DM. Recurrent hypoglycaemia was also increased in T1DM + CD, although hypoglycaemia was not independently associated with fractures. Prospective studies are required to determine the long‐term impacts of CD on bone health and glycaemic control in patients with T1DM.

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“…In adult patients with T1DM, no significant change of HbA1c levels was found, when comparing before CD diagnosis, at CD diagnosis and after treatment of CD by a GFD [ 50 , 51 ]. This data is confirmed in a recent population based cohort study which found that having a diagnosis of CD does not influence the risk of hospital admission due to hypoglycaemia, keto-acidosis or coma in T1DM patients [ 52 ].…”

Section: Clinical Consequences Of CD In Adult Patients With T1dmsupporting

confidence: 66%

Screening for coeliac disease in adult patients with type 1 diabetes mellitus: myths, facts and controversy

Bakker

Tushuizen

Blomberg

et al. 2016

Diabetol Metab Syndr

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This review aims at summarizing the present knowledge on the clinical consequences of concomitant coeliac disease (CD) in adult patients with type 1 diabetes mellitus (T1DM). The cause of the increased prevalence of CD in T1DM patients is a combination of genetic and environmental factors. Current screening guidelines for CD in adult T1DM patients are not uniform. Based on the current evidence of effects of CD on bone mineral density, diabetic complications, quality of life, morbidity and mortality in patients with T1DM, we advise periodic screening for CD in adult T1DM patients to prevent delay in CD diagnosis and subsequent CD and/or T1DM related complications.

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A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

Abstract: Having a diagnosis of CD is unlikely to influence the risk of coma, ketoacidosis and hypoglycemia in T1D patients.

Cited by 10 publications

References 36 publications

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

Increased prevalence of fracture and hypoglycaemia in young adults with concomitant type 1 diabetes mellitus and coeliac disease

Screening for coeliac disease in adult patients with type 1 diabetes mellitus: myths, facts and controversy

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