Type 1 diabetes mellitus and celiac disease: endothelial dysfunction

Abstract

In the observational study cited above, we evaluated whether the presence of undiagnosed CD in a group of adult DM1 patients is associated with a different expression of some hemostatic factors, as well as with a different manifestation and/or progression of microvascular complications in comparison with patients suffering from DM1 only. The Ventura group has carefully examined and commented on this study, but we are only partially in agreement with their observations. First, the including criterion HbA1c B 7.5% or 58 mmol/mol was chosen to ensure the selection of DM1 patients with a satisfactory long-standing metabolic control. This is to prevent that, during the disease progression, an inadequate metabolic control may have affected adversely on the study parameters. The evaluation of hemostatic factors and microvascular complications in DM1 patients also suffering from CD and presenting an unsatisfactory metabolic control could become the object of a future study.Second, we have chosen to assess the metabolic control by means of HbA1c in order to obtain long-standing information reflecting the chronic state that may culminate in microvascular complications. On the other hand, the metabolic control of adult patients with a long-standing DM1 is generally better than that found in diabetic children, to whom the Ventura group refers. This is because children have a shorter disease duration and they are more exposed to factors that can alter their metabolic control. In relation to the other parameters able to evaluate the metabolic control, the diabetologists have obviously considered the presence of frequent hypoglycemic events, the extreme glycemia variability, and the increment in daily insulin needs as an implicit exclusion criterion.Third, in most of the patients evaluated in our study, the presence of other autoimmune diseases has been investigated by means of a wide autoantibody serum panel (data not shown), and the results are not relevant. Finally, since our study was performed on a group of adult DM1 patients, we have obviously not considered anthropometric parameters because the patients enrolled in our study were all already adult, eventually affected by CD, and presenting negative malabsorption clinical picture. It would however be interesting to assess, in the future, the role of CD on hemostatic factors and microvascular complications also in diabetic children.In conclusion, we observed a better metabolic control and a thromboresistant condition in adult patients with both DM1 and undiagnosed CD, even if our opinion is that gluten-free diet is mandatory in all patients suffering from CD.Rome. 22 July 2011.

A Population-Based Study of the Risk of Diabetic Retinopathy in Patients With Type 1 Diabetes and Celiac Disease

“…Research has largely focused on studying the prevalence of CD in T1D (8,9), as well as the benefits of starting a gluten-free diet in asymptomatic CD within the T1D population (9,22). Few studies have examined the risk of complications in patients with both conditions (10,11,23), and none have thus far been able to determine time-specific risks for T1D complications.…”

“…Hypercholesterolemia and hypertension increase the risk of DRP (3). Recently, Picarelli et al (10) demonstrated that patients with T1D and CD had lower levels of HbA 1c , triglycerides, and cholesterol than patients with only T1D. These researchers (10) found no signs of retinal or renal abnormalities in patients with T1D and CD (10), but the study was cross-sectional without follow-up.…”

“…Such studies are warranted to clarify the need for screening routines in T1D patients. A recent study (10) addressing T1D complications in the presence of CD found no retinal abnormalities in T1D patients with CD (10). However, that study only enrolled 13 patients with CD and T1D, and there was no follow-up after the diagnosis of CD (10).…”

“…A recent study (10) addressing T1D complications in the presence of CD found no retinal abnormalities in T1D patients with CD (10). However, that study only enrolled 13 patients with CD and T1D, and there was no follow-up after the diagnosis of CD (10). We previously found a higher prevalence of advanced DRP in patients with T1D and CD than in T1D control subjects without CD (11), but that study was limited in size (T1D and CD: n = 12), and follow-up ended after 1 year.…”

The thrombophilic network of autoantibodies in celiac disease

“…Recently, Ieko et al [58] reported that aPS/PT IgG recognizes prothrombin bound to phosphatidylserine on platelets and endothelial cells and, directly or via Fc-gamma receptors, activates a variety of procoagulant agents. However, the complementary aspects of CD are endothelial dysfunction [59], platelet abnormalities [60,61] and increased apoptosis [62]. Thus, it is suggested that intestinal injury, endothelial dysfunction, platelet abnormalities and enhanced apoptosis cause increased exposure of phospholipids or new epitopes, which are the origin of aPT, aPL and aPS/PT autoantibodies.…”