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

Abstract

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.

Glycemic control and bone mineral density in children and adolescents with type 1 diabetes

“…Children aged 6 to 17 years diagnosed with type 1 diabetes were included. Children with any bone disease (eg, infantile osteopetrosis, hemihyperplasia), presence of other chronic diseases that might affect bone metabolism (eg, celiac disease, thyroid disorder), and previous or current treatment with medication that could alter the bone metabolism (eg, systemic glucocorticoids) were excluded . In addition, patients unable to co‐operate with the study protocol were also excluded.…”

“…The mechanisms of diabetic osteopenia and bone fragility in patients with type 1 diabetes are not fully understood. The pathogenesis is probably multifactorial, and diabetes may indirectly affect the bone metabolism in a number of ways including hypogonadism, hypercalciuria, altered vitamin D metabolism, or through associations with other diseases that influences the bones, for example, coeliac disease . Adult patients with type 1 diabetes have low bone mineral density (BMD) in the spine and hip, and are also showing signs of impaired bone formation with low levels of osteocalcin and increased bone resorption biomarkers .…”

<p>Type 1 Diabetes and Bone Fragility: Links and Risks</p>

“…A cohort study by Thayakaran et al reported an increased fracture risk with increasing HbA1c, although with a more modest risk increase of 1.01 per mmol/mol increase 52. Although it is tempting to conclude that hyperglycemia may explain the increased fracture risk, other studies report no association between HbA1c and fracture,53,54 and the available data for patients with T1D is limited. The hypothesis of bone fragility due to hyperglycemia and development of AGEs is based on limited evidence and needs to be confirmed in both mechanistic studies and cohort studies.…”

“…T1D is associated with thyroid disease and celiac disease 62. Both hypothyroidism and hyperthyroidism are associated with an increased fracture risk63 and celiac disease is associated with an increased fracture risk in patients with T1D 54. A study by Dhaliwal et al reported data on 756 patients with T1D and found a borderline significant association between fractures and celiac disease (p=0.06) 53.…”

Celiakijos Ir 1 Tipo Cukrinio Diabeto Ryšys

“…praėjus > 10 metų po 1 tipo CD diagnozavimo [9]. Pastebėta, jog, sergant 1 tipo CD, randami reikšmingai žemesni autoantikūnių titrai nei bendrojoje populiacijoje, todėl diagnozės patvirtinimui rekomenduojama atlikti gaurelių biopsiją, nors simptomatika ir nėra stipriai išreikšta ar stebimi žemi serologiniai titrai [9,17,18].…”