Type 1 diabetes mellitus and celiac disease: endothelial dysfunction

Abstract

Many reports indicate a hypercoagulative state in diabetes mellitus as result of endothelial damage. Experimental evidence suggests that a metabolic derangement triggers a cascade of biochemical events that lead to vascular dysfunction. The net effect is to convert the endothelium from thromboresistant to thrombogenic surface. In literature, a strong association between type 1 diabetes mellitus (DM1) and celiac disease (CD) has been reported. We do not have information about the hemostatic system in these associated conditions. Our study aims at evaluating whether the presence of CD in a group of DM1 patients is associated with a different expression of some hemostatic factors and with a different manifestation and/or progression of microvascular complications of DM1 in comparison with patients with only diabetes. Ninety-four adult DM1 patients were enrolled in the study and subsequently screened for CD. Anti-endomysial antibodies (EMA) were positive in 13 of 94 DM1 patients (13.8%). CD diagnosis was confirmed by histology and organ culture. The mean age and duration of DM1 of patients also affected by CD were similar to those of only diabetic patients, but the metabolic control and the hemocoagulative parameters were significantly different between the two groups: DM1 patients also affected by CD presented significantly lower concentrations of glycosylated hemoglobin (HbA1c) (P < 0.05), cholesterol (P < 0.001), triglycerides (P < 0.001), factor VII antigen (FVII:ag) (P < 0.005), factor VII coagulant activity (FVII:c) (P < 0.05), and prothrombin degradation fragments (F1+2) (P < 0.001), as well as higher values of activated C protein (APC) (<0.001). No retinal abnormalities and no signs of renal damage were observed in DM1 patients also affected by CD. Our results suggest a potential protective role of CD in the prothrombotic state of DM1.

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

“…Thus, a diet with low glycemic index is suggested either because of a lack of normal insulin response to high glycemic index foods in diabetes patients, or because of the aim of reducing micro and macrovascular complications [21,39] . Indeed, we have seen that GFD seems to have a protective role rather than a deteriorating one [32,33] , even in pediatric age [40] . The means by which the presence of celiac disease might prevent micro-and macrovascular complications of diabetes asks further investigations.…”

“…Picarelli et al [33] , evaluated whether the presence of celiac disease in a group of type 1 diabetes patients is associated with different expression of some hemostatic factors and with a different manifestation/progression of complications. The authors claim a potential protective role of celiac disease in the prothrombotic state of type 1 diabetes (celiac disease patients had significantly lower HbA1c, total cholesterol, triglycerides, factor Ⅶ antigen, factor Ⅶ coagulant activity, and prothrombin degradation fragments).…”

Advanced glycation end products (AGEs) and the soluble receptor for AGE (sRAGE) in patients with type 1 diabetes and coeliac disease

“…Our findings suggest that other mechanisms are responsible for the differences in microvascular complications between these groups. A GFD may lead to lower cholesterol levels and lower BMI, both traditional cardiovascular risk factors [11]. In addition, a recent study of Pham et al found that non-adherence to a gluten-free diet was associated with an elevated albumin-excretion rate [20].…”

“…The role of (un)treated CD on the development of diabetic long term complications has been reported either to be protective [6,7,11] or to be aggravating [8,10,12].…”

Long Term Follow Up of Celiac Disease—Is Atherosclerosis a Problem?

“…They showed increased c-IMT in CD patients in comparison to healthy controls, and the highest c-IMT in patients with both CD and T1DM. The data exist to support decreased endothelial damage and protective role of CD in diabetic patients due to lower status of some haemostatic factors against prothrombotic phase leading to vascular dysfunction [64]. In a study by Leeds et al [65] the biochemical parameters and lipids’ profile, as well as the degree of neuropathy, retinopathy and nephropathy in adult T1DM patients with CD were analyzed.…”