Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

Sud, Shama; Marcon, Margaret; Assor, Esther; Palmert, Mark R.; Daneman, Denis; Mahmud, Farid H.

doi:10.1155/2010/161285

Cited by 66 publications

(101 citation statements)

References 126 publications

(160 reference statements)

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“…Usually, celiac autoantibodies are tested at the time of diabetes onset and yearly during follow-up, but debate exists about timing and frequency for screening [12,13] . When celiac antibodies are detected (ideally confirmed at least twice), it is mandatory to perform esophagogastroduodenoscopy with bowel biopsies to confirm diagnosis [14] .…”

Section: Introductionmentioning

confidence: 99%

Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control

Scaramuzza

Mantegazza²,

Bosetti³

et al. 2013

WJD

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Type 1 diabetes mellitus is associated with celiac disease, with a prevalence that varies between 0.6% and 16.4%, according to different studies. After a diagnosis of celiac disease is confirmed by small bowel biopsy, patients are advised to commence a gluten-free diet (GFD). This dietary restriction may be particularly difficult for the child with diabetes, but in Europe (and in Italy) many food stores have targeted this section of the market with better labeling of products and more availability of specific GFD products. Treatment with a GFD in symptomatic patients has been shown to improve the symptoms, signs and complications of celiac disease. However, the effects of a GFD on diabetic control are less well established. Initial reports of improved hypoglycemic control were based on children who were diagnosed with celiac disease associated with malabsorption, but there have subsequently been reports of improvement in patients with type 1 diabetes with subclinical celiac disease. There are other studies reporting no effect, improved control and an improvement of hypoglycemic episodes. Moreover, in this review we wish to focus on low glycemic index foods, often suggested in people with type 1 diabetes, since they might reduce postprandial glycemic excursion and enhance longterm glycemic control. In contrast, GFD may be rich in high glycemic index foods that can increase the risk of obesity, insulin resistance and cardiovascular disease, worsening the metabolic control of the child with diabetes. Hence, it is important to evaluate the impact of a GFD on metabolic control, growth and nutritional status in children with type 1 diabetes.

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Section: Introductionmentioning

confidence: 99%

Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control

Scaramuzza

Mantegazza²,

Bosetti³

et al. 2013

WJD

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“…Furthermore, this disease is characterised by autoantibodies to TGM2 [19]. The coexistence of type 1 diabetes and celiac disease [63] might thus, in part, be related to TGM2. In this context, it is interesting that the naturally occurring proteolytic cleavage product of chromogranin A, the WE14 peptide, becomes a highly antigenic T cell epitope following in vitro treatment with transglutaminase [54,55].…”

Section: Discussionmentioning

confidence: 99%

Do post-translational beta cell protein modifications trigger type 1 diabetes?

et al. 2013

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Type 1 diabetes is considered an autoimmune disease characterised by specific T cell-mediated destruction of the insulin-producing beta cells. Yet, except for insulin, no beta cell-specific antigens have been discovered. This may imply that the autoantigens in type 1 diabetes exist in modified forms capable of specifically triggering beta cell destruction. In other immune-mediated diseases, autoantigens targeted by the immune system have undergone post-translational modification (PTM), thereby creating tissue-specific neo-epitopes. In a similar manner, PTM of beta cell proteins might create beta cell-specific neo-epitopes. We suggest that the current paradigm of type 1 diabetes as a classical autoimmune disease should be reconsidered since the immune response may not be directed against native beta cell proteins. A modified model for the pathogenetic events taking place in islets leading to the T cell attack against beta cells is presented. In this model, PTM plays a prominent role in triggering beta cell destruction. We discuss literature of relevance and perform genetic and human islet gene expression analyses. Both direct and circumstantial support for the involvement of PTM in type 1 diabetes exists in the published literature. Furthermore, we report that cytokines change the expression levels of several genes encoding proteins involved in PTM processes in human islets, and that there are type 1 diabetes-associated polymorphisms in a number of these. In conclusion, data from the literature and presented experimental data support the notion that PTM of beta cell proteins may be involved in triggering beta cell destruction in type 1 diabetes. If the beta cell antigens recognised by the immune system foremost come from modified proteins rather than native ones, the concept of type 1 diabetes as a classical autoimmune disease is open for debate.

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“…5-10% of patients with T1D develop CD. In many cases CD is discovered after screening initiated after the onset of diabetes, where the individuals often are asymptomatic or have diffuse symptoms [217]. Several studies have revealed an association between CD and Down's syndrome, since there is an increased prevalence of CD among patients with Down's syndrome [218,219].…”

Section: Associated Diseasesmentioning

confidence: 99%

Studies of Mucosal Immune Regulation in Celiac Disease and Type 1 Diabetes

Lahdenperä¹

2014

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Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

Cited by 66 publications

References 126 publications

Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control

Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control

Do post-translational beta cell protein modifications trigger type 1 diabetes?

Studies of Mucosal Immune Regulation in Celiac Disease and Type 1 Diabetes

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