Occurrence of Celiac Disease After Onset of Type 1 Diabetes: A 6-Year Prospective Longitudinal Study

Barera, Graziano; Bonfanti, Riccardo; Viscardi, Matteo; Bazzigaluppi, Elena; Calori, Giliola; Meschi, Franco; Bianchi, Cesare; Chiumello, G

doi:10.1542/peds.109.5.833

Cited by 241 publications

(236 citation statements)

References 33 publications

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“…In a prospective 6-year study on children who had diabetes and CD, no patients were found to develop CD Ͼ4 years after diabetes onset. 23 Therefore, we suggest that screening for CD should be performed annually on patients with negative CD serology at diabetes onset for a minimal duration of 4 years. This strategy should be evaluated in prospective studies to confirm that antitTG limited testing is a cost-effective method to identify CD.…”

Section: Resultsmentioning

confidence: 99%

“…More often, CD is diagnosed shortly after or sometimes years after the onset of type 1 diabetes. 5,[21][22][23] To determine the temporal relationship between the onset of type 1 diabetes and CD, we tested for anti-tTG in the initial serum taken at the onset of diabetes using our serum library. The retroactive screening showed that only 1 of 11 patients (patient 11)-the one with a positive jejunal biopsy-was anti-tTG negative at the onset of the type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

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The Temporal Relationship Between the Onset of Type 1 Diabetes and Celiac Disease: A Study Based on Immunoglobulin A Antitransglutaminase Screening

et al. 2004

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ABSTRACT. Objective. The association of celiac disease (CD) and type 1 diabetes is now clearly documented. Immunoglobulin A (IgA) antitransglutaminase antibodies were measured to determine the prevalence of celiac disease in a diabetic population of children and to determine the temporal relationship between type 1 diabetes onset and CD.Methods. We measured IgA antitransglutaminase antibodies using human recombinant antigen in parallel with classical markers (IgA and IgG antigliadin, IgA antiendomysium) in 284 children with diabetes.Results. In the population studied, the prevalence of CD was 3.9% (11 of 284). Two cases of CD were diagnosed before the onset of diabetes, and in 8 patients, the diagnoses of CD and diabetes were concomitant, suggesting that CD was present before the onset of diabetes. In 1 case, a girl who presented with thyroiditis, serology for CD became positive after diabetes had been diagnosed.Conclusion. An excellent correlation was observed between IgA antiendomysium and IgA antitransglutaminase antibodies. We therefore propose using IgA antitransglutaminase as a screening test for practical reasons. Furthermore, IgA antitransglutaminase levels and mucosa abnormalities were closely correlated. The presence of antitransglutaminase antibodies should alert pediatricians to the atypical forms of CD. This study indicates that CD is most often present before the onset of diabetes. Pediatrics 2004;113:e418 -e422. URL: http: //www.pediatrics.org/cgi/content/full/113/5/e418; celiac disease, type 1 diabetes, children, screening test, antitransglutaminase autoantibodies, prevalence, autoimmune diseases.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Temporal Relationship Between the Onset of Type 1 Diabetes and Celiac Disease: A Study Based on Immunoglobulin A Antitransglutaminase Screening

et al. 2004

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“…2 It is also unclear why patients with recently developed T1D have a higher likelihood of developing CD than patients with long-lasting T1D. 36,45 It is possible that a subgroup of T1D patients might have certain specific characteristics that condition the development T1D and CD in the same person.…”

Section: Discussionmentioning

confidence: 99%

Celiac disease in patients with type 1 diabetes: a condition with distinct changes in intestinal immunity?

et al. 2011

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Two common chronic childhood diseases-celiac disease (CD) and type 1 diabetes (T1D)-result from complex pathological mechanisms where genetic susceptibility, environmental exposure, alterations in intestinal permeability and immune responses play central roles. In this study, we investigated whether these characteristics were universal for CD independently of T1D association. For this purpose, we studied 36 children with normal small-bowel mucosa and 26 children with active CD, including 12 patients with T1D. In samples from the small-bowel mucosa, we detected the lowest expression of tight junction protein 1 (TJP1) mRNA in CD patients with T1D, indicating an increase in intestinal permeability. Furthermore, these samples displayed the highest expression of forkhead box P3 (FoxP3) mRNA, a marker for regulatory T cells, as compared with other patient groups. At the same time, serum levels of IgA antibodies specific for the CD-related antigens deamidated gliadin and tissue transglutaminase (tTG) were the highest in CD patients with T1D. In contrast, no significant differences were found in IgA or IgG antibodies specific for bovine beta-lactoglobulin or Bifidobacterium adolescentis DSM 20083-derived proteins. There were also no differences in the transamidating activity of serum autoantibodies between patients and control individuals. Our results show that patients with T1D and newly detected CD exhibit severely altered intestinal permeability, strong local immune activation and increased immunoregulatory mechanisms in the small bowel. Further study is required to determine whether these extreme changes in this CD subgroup are due to some specific environmental factors (virus infections), unknown genetic effects or autoimmune reactions to antigenic targets in intracellular tight junctions. INTRODUCTIONWith an approximate prevalence of 1.0% in Western countries, celiac disease (CD) is one of the most common lifelong chronic disorders. 1 CD and type 1 diabetes (T1D) form a significant sector of childhood diseases with high rate of co-occurrence. 2 Both diseases are autoimmune in origin and develop as a result of complex pathological mechanisms, involving several common genetic, environmental and immunological factors. Among these, the common susceptibility loci of HLA and other immune system-related genes, 3 permeability changes in the small-bowel mucosa, 4 and association with wheat consumption 4,5 are prominent. Both diseases are increasing in most regions of the world, 6,7 as are several other autoimmune diseases, but the actual cause of the disease remains unknown. However, several recent studies have highlighted the role of environmental and social changes that have taken place over the last several decades. 8,9 The central event in the pathogenesis of CD is damage to the small intestinal mucosa that occurs after ingestion of gluten or related prolamins in genetically susceptible individuals. During this process, several morphological and immunological alterations have been demonstrated in the small-bowel mucos...

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“…In Italy, the prevalence of celiac disease in children with type 1 diabetes is around 7% [9,10] , 3.6% of which at type 1 diabetes onset [9] , at a younger age [10] and in boys [10] ; moreover, according to a study by Salardi et al [11] , the prevalence of celiac disease has significantly increased since 1994 (10.6% vs 6.6%, P = 0.015), probably due to changes in environmental factors, namely, eating habits and viral infections.…”

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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Occurrence of Celiac Disease After Onset of Type 1 Diabetes: A 6-Year Prospective Longitudinal Study

Cited by 241 publications

References 33 publications

The Temporal Relationship Between the Onset of Type 1 Diabetes and Celiac Disease: A Study Based on Immunoglobulin A Antitransglutaminase Screening

The Temporal Relationship Between the Onset of Type 1 Diabetes and Celiac Disease: A Study Based on Immunoglobulin A Antitransglutaminase Screening

Celiac disease in patients with type 1 diabetes: a condition with distinct changes in intestinal immunity?

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

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