The prevalence of coeliac disease in adult Danish patients with type 1 diabetes with and without nephropathy

Abstract

To the Editor: Coeliac disease causes malabsorption due to small bowel villous atrophy, which normalises when gluten, which is found in wheat, rye and barley, is withdrawn from the diet. Coeliac patients should be treated with a gluten-free diet that corrects the intestinal malabsorption and protects against the development of osteoporosis and intestinal lymphoma.As shown in several studies (review [1]), type 1 diabetes is associated with a high prevalence (2-10%) of coeliac disease. This has, in part, been explained by genetic factors, in particular by increased frequencies of HLA-DR3 and HLA-DQ2 [2]. Coeliac symptoms are often absent or atypical in type 1 diabetic patients and the diagnosis is therefore often delayed.Diabetic nephropathy is the leading cause of end-stage renal disease and develops in approximately one-third of type 1 diabetic patients within the first 20 years of diabetes.The pathogenesis of diabetic nephropathy is only partially understood. In addition to genetic factors, haemodynamic, metabolic and growth factors are generally accepted to contribute [3]. As in diabetic nephropathy [4], reduced final height is a significant clinical manifestation of coeliac disease. In this study we investigated the prevalence of coeliac disease in adult Danish type 1 diabetes patients, with the specific aim of studying whether undiagnosed coeliac disease is more prevalent in type 1 diabetic patients with diabetic nephropathy than in type 1 diabetic patients without nephropathy.We studied 967 type 1 diabetic patients [5]. . Median age at onset of diabetes was 12 (range: 0-47) and 18 (range: 0-64) years in the nephropathy and normoalbuminuric groups respectively (p<0.001).Total serum IgA concentration (in-house ELISA; Statens Serum Institute, Copenhagen, Denmark) and IgA anti-transglutaminase concentration (anti-tTG, commercial ELISA, Celikey; Pharmacia, Freiburg, Germany) were measured in a single random blood sample. The specificity and sensitivity values of the IgA anti-tTG assays were 99 and 96% respectively. The presence of IgA anti-tTG is highly indicative of coeliac disease even in asymptomatic cases [6]. Patients positive after screening were referred to their local hospital for a possible small bowel biopsy procedure and instructions for a gluten-free diet. Sera from five subjects with IgA deficiency (<0.1 mg/ml) were analysed for IgG anti-gliadin antibodies and IgG anti-tTG. We collected clinical data and laboratory results using a questionnaire including questions concerning possible earlier diagnosis of coeliac disease and possible previous gluten-free diet.

High Prevalence of Microvascular Complications in Adults With Type 1 Diabetes and Newly Diagnosed Celiac Disease

“…A study of 967 people with type 1 diabetes, of which 462 had nephropathy, found no difference in the prevalence of CD (15). A study of children with type 1 diabetes and established CD on a GFD was compared with a control group with diabetes alone.…”

“…Two previous studies have examined the effect of CD on diabetic nephropathy but were conflicting (15,16). There are currently no studies examining the prevalence of retinopathy in individuals with both type 1 diabetes and CD.…”

Cesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in Children

“…55 Interestingly, an enhanced cesarean delivery rate was also described for type 1 diabetes, an autoimmune condition that has immunologic overlap with celiac disease. [56][57][58] Moreover, a moderately enhanced cesarean delivery rate has been described in mothers with both celiac disease and IBD. 59,60 Given the strong genetic factor in the pathogenesis of both diseases, the enhanced cesarean delivery rate might have contributed to an association between cesarean delivery and celiac disease; however, information on the family history was not obtained and genetic testing of patients and control subjects was not performed in our study.…”

Induced Pluripotent Stem Cells: Therapeutic Applications in Monogenic and Metabolic Diseases, and Regulatory and Bioethical Considerations

“…In any case, the final result is the destruction of beta cells and progressive impairment of the blood glucose metabolism [82]. Some patients with type 1 diabetes may show a higher susceptibility to other conditions such as thyroiditis, Graves disease, Adisson disease, celiac disease, myasthenia gravis or to degenerative skin conditions such as vitíligo [83][84][85].…”