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Celiac disease in adult patients with type 1 diabetes mellitus


Authors: Iva Haladová;  Daniela Čechurová;  Silvie Lacigová;  J. Gruberová;  Zdeněk Rušavý;  Karel Balihar
Authors‘ workplace: Diabetologické centrum I. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Martin Matějovič, Ph. D.
Published in: Vnitř Lék 2014; 60(7-8): 562-566
Category: Original Contributions

Overview

Objective:
To assess the prevalence of celiac disease in adult patients with type 1 diabetes mellitus (T1DM). Influence the new started treatment of celiac disease on glycemic control and body mass index (BMI) of the patients. Prevail the anti-transglutaminase antibody (atTG) positivity one year after commencement of the therapy.

Methods:
A retrospective assessment of celiac disease targeted screening in 465 adult T1DM patients at Diabetes Center, 1st Medical Department, University Hospital in Pilsen (80 % of all T1DM patients) from 1. 1. 2007 until 1. 7. 2011. Enterobiopsy was indicated in case of atTG-A (or atTG-G) positivity. In patients with newly started gluten-free diet, HbA1c and BMI within a year after diagnosis of celiac disease were compared to a year period six months after treatment commencement (3–4 visits), atTG was evaluated one year after treatment beginning. Paired T-test was used for statistical evaluation.

Results:
The prevalence of all forms of celiac disease in the studied group was 10.5 %. Celiac disease diagnosed in childhood was found in 1.1 % patients (5/465). Positivity of atTG was newly observed in 9.5 % (44/465) patients. Three patients with atTG > 300 kIU/l refused the enterobiopsy examination. Celiac disease is highly plausible. The influence of gluten-free diet on BMI and HbA1c could not be evaluated due to the lack of compliance. 22 patients had a potential form of celiac disease (negative histology). Positive enterobiopsy was found in 19 patients (4.1 %). Another 3 patients had to be excluded from the subgroup of 22 patients (newly indicated gluten-free diet) as the HbA1c values and BMI were affected by the primary diagnosis of T1DM.

Subgroup cha­racteristics:
9 women and 7 men, mean age 38 ± 12 years, diabetes duration 21 ± 13 years, celiac disease diagnosed 20.7 ± 13 years since first diagnosis of T1DM. No statistically significant change in HbA1c (67 ± 11.4 vs 69 ± 13.9 mmol/mol) was observed in the studied period, however and a significant change of BMI from 25.4 ± 4.2 to 25.9 ± 4.3 (p < 0.01) was found. The atTG positivity prevailed in 47 % (9/19) of patients after one year.

Conclusion:
A total prevalence of the celiac disease in the group of adult T1DM patients was 10.5 %. No significant change in HbA1c occurred following treatment, a significant change of BMI was observed. The atTG positivity prevailed in 47 % of patients after one year.

Key words:
celiac disease – gluten free diet – prevalence – type 1 diabetes


Sources

1. Mustalahti K, Catassi C, Reunanen et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med 2010; 42(8): 587–595.

2. Collin P, Kaukinen K, Valimaki M et al. Endocrinological disorders and celiac disease. Endocr Rev 2002; 23(4): 464–483.

3. Aggarwal S, Lebwohl B, Green PH. Screening for celiac disease in average- risk and high- risk populations. Therap Adv Gastroenterol 2012; 5(1): 37–47.

4. Greco D, Pisciotta M, Gambina F et al. Celiac disease in subjects with type 1 diabetes mellitus: a prevalence study in western Sicily (Italy). Endocrine 2013; 43(1): 108–111.

5. Cerruti F, Bruno G, Chiarelli F et al. Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes: an Italian multicenter study. Diabetes Care 2004; 27(6): 1294–1298.

6. Mahmud FH, Murray JA, Kudva YC et al. Celiac disease in type 1 diabetes mellitus in a North American community: prevalence, serologic screening and clinical features. Mayo Clin Proc 2005; 80(11): 1429–1434.

7. Prokopová L. Celiakie – co má vědět ambulantní internista. Interní medicína pro praxi 2008; 10(5): 233–239.

8. Page SR, Lloyd CA, Hill PG et al. The prevalence of coeliac disease in adult diabetes mellitus. QJM 1994; 87(10): 631–637.

9. Frič P. Cílený screening celiakie (metodický pokyn). Věstník MZ-ČR; částka 3, z 28. 2. 2011: 51–54.

10. Auricchio R, Tosco A, Piccolo E et al. Potential celiac children: 9-year follow-up on a gluten- containing diet. Am J Gatroenterol 2014; 109(6): 913–921.

11. Šumník Z, Koloušková S, Malcová H et al. High prevalence of coeliac disease in siblings of children with type 1 diabetes. Eur J Pediatr 2005; 164(1): 9–12.

12. Prázný M, Škrha J, Límanová Z et al. Screening for Associated Autoimmunity in Type 1 Diabetes Mellitus With Respect To Diabetes Control. Physiol. Res 2005; 54(1): 41–48.

13. Saukkonen T, Savilahti E, Reijonen H et al. Coeliac disease: frequent occurrence after clinical onset of insulin – dependent diabetes mellitus. Childhood Diabetes in Finland Study Group. Diabet Med 1996; 13(5): 464–470.

14. Cerutii F, Bruno G, Chiarelli F et al. Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes. Diabetes Care 2004; 27(6): 1294–1298.

15. Ludvigsson JF, Ludvigsson J, Ekbom A et al. Celiac disease and risk of subseguent type 1 diabetes: a general population cohort study of children and adolescents. Diabetes Care 2006; 29(11): 2483–2488.

16. Tiberti C, Panimolle F, Bonamico M et al. Long-standing type 1 diabetes: patients with adult-onset develop celiac-specific immunoreactivity more frequently than patients with childhood-onset diabetes, in a disease duration-dependent manner. Acta Diabetol 2014. Epub ahead of print.

17. Pham- Short A, Donaghue KC, Ambler G et al. Coeliac disease in Type 1 diabetes from 1990 to 2009: higher incidence in young children after longer diabetes duration. Diabet Med 2012; 29(9): e286-e289. Dostupné z DOI: <http://doi: 10.1111/j.1464–5491.2012.03720.x>.

18. Biagi F, Trotta L, Alfano C et al. Prevalence and natural history of potential celiac disease in adult patients. Scand J Gastroenterol 2013; 48: 537–542.

19. Franzese A, Iafusco D, Spadaro R et al. Potential celiac disease in type 1 diabetes: a multicenter study. Diabetes Res Clin Pract 2011; 92(1): 53–56.

20. Tosco A, Salvati VM, Auricchio R et al. Natural history of potential celiac disease in children. Clin Gastroenterol Hepatol 2011; 9(4): 320–325.

21. Fasano A, Catassi C. Coeliac disease in children. Best Pract Res Clin Gastroenterol 2005; 19(3): 467–478.

22. Sponzilli I, Chiari G, Iovane B et al. Celiac disease in children with type 1 diabetes: impact of gluten free diet on diabetes management. Acta Biomed 2010; 81(3): 165–170.

23. Abid N, McGlone O, Cardwell C et al. Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease. Pediatric Diabetes 2011; 12(4 Pt 1): 322–325.

24. Rami B, Šumník Z, Schober E et al. Screening detected celiac disease in children with type 1 diabetes mellitus: effect on the clinical course (a case control study). J Pediatr Gastroenterol Nutr 2005; 41(3): 317–321.

25. Taler I, Philip M, Lebenthal Y et al. Growth and metabolic control in patients with type 1 diabetes and celiac disease: a longitudinal observational case control study. Pediatr Diabetes 2012; 13(8): 597–606.

26. Sun S, Puttha R, Ghezaiel S et al. North West England Paediatric Diabetes Network. The effect of biopsy- positive silent coeliac disease and treatment with gluten- free diet on growth and glyceamic control in children with Type 1 diabetes. Diabet Med 2009; 26(12): 1250–1254.

27. Acerini CL, Ahmed ML, Ross KM et al. Coeliac disease in children and adolescents with IDDM: clinical characteristics and response to gluten- free diet. Diabet Med 1998; 15(1): 38–44.

28. Mariani MG, Viti M, Montuori et al. The gluten-free diet: a nutritional risk factor for adolescents with celiac disease. J Pediatr Gastroenterol Nutr 1998; 27(5): 519–523.

29. Wild GG, Robins VJ, Burley H et al. Evidence of high sugar intake and low fibre and mineral intake in the gluten free diet. Aliment Pharmacol Ther 2010; 32(4): 573–581.

30. Errichiello S, Esposito O, Di Mase R et al. Celiac disease: predictors of compliance with a gluten- free diet in adolescents and young adults. J Pediatr Gastroenterol Nutr 2010; 50(1): 54–60.

31. Škrha J. Celiakie a diabetes. Vnitř Lék 2011; 57(4): 375–377.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 7-8

2014 Issue 7-8

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