Celiac disease in type 1 diabetes mellitus

Abstract

Celiac Disease (CD) occurs in patients with Type 1 Diabetes (T1D) ranging the prevalence of 4.4-11.1% versus 0.5% of the general population. The mechanism of association of these two diseases involves a shared genetic background: HLA genotype DR3-DQ2 and DR4-DQ8 are strongly associated with T1D, DR3-DQ2 with CD. The classical severe presentation of CD rarely occurs in T1D patients, but more often patients have few/mild symptoms of CD or are completely asymptomatic (silent CD). In fact diagnosis of CD is regularly performed by means of the screening in T1D patients. The effects of gluten-free diet (GFD) on the growth and T1D metabolic control in CD/T1D patient are controversial. Regarding of the GFD composition, there is a debate on the higher glycaemic index of gluten-free foods respect to gluten-containing foods; furthermore GFD could be poorer of fibers and richer of fat. The adherence to GFD by children with CD-T1D has been reported generally below 50%, lower respect to the 73% of CD patients, a lower compliance being more frequent among asymptomatic patients. The more severe problems of GFD adherence usually occur during adolescence when in GFD non compliant subjects the lowest quality of life is reported. A psychological and educational support should be provided for these patients.

Coeliac disease and type 1 diabetes mellitus: epidemiology, clinical implications and effects of gluten-free diet

“…They found CD in 22 patients [8]. In addition, in accordance with previous studies, they confirmed that CD is more prevalent in female subjects with T1DM than in males [5] and that the age of onset of T1DM is younger in patients with double the disease than in those with diabetes only [6].…”

“…For a patient with T1DM, already engaged in coping day by day with a complex chronic disease, the addition of a second 'limiting' condition is probably remarkably difficult. Above all for a child or adolescent, the balance between GFD adherence and daily life is difficult to achieve, and the need to coordinate insulin therapy with proper nutrition and a healthy lifestyle, in order to maintain adequate metabolic control, is already a considerable effort for the young T1DM patient and families [6]. We suggest, however, that the importance of GFD should be stressed for its severe complications such as lymphoma [2], perhaps by ensuring adequate psychological and nutritional support.…”

“…The prevalence of CD among adults and children with T1DM varies in different geographical populations and is observed to range between 1 and 11 % [4][5][6][7]. This close association has been ascribed to the same HLA pattern, namely HLA-DQ2 and/or DQ8, which predisposes individuals to both disorders.…”

MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus

“…In poorly controlled diabetes, excessive renal loss of calcium and magnesium may occur. Coeliac disease occurs in 4-11% of patients with T1DM as opposed to !1% in the general population and should be screened for with serum endomysial antibody assays in those at risk of fracture (91,122,123). If the diagnosis is confirmed with intestinal histology, a gluten-free diet is indicated.…”

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

“…HLA-DQ8 also confers a risk of type 1 diabetes [4] . Celiac disease affects at least 10% of patients with type 1 diabetes at some point in their lives [5] , with a prevalence that varies between 0.6%-16.4%, according to different studies [6][7][8] . The prevalence of celiac disease among children with type 1 diabetes is significantly higher than in non-diabetic children (in Western countries celiac disease affects around 1%-2% of the non-diabetic population).…”