link.springer.com

Type 1 diabetes and celiac disease in adults: glycemic control and diabetic complications - Acta Diabetologica

  • ️Simsek, Suat
  • ️Fri Apr 27 2012

Abstract

The prevalence of celiac disease (CD) in patients with type 1 diabetes mellitus (T1DM) is 4.5 %. Objective of the study is to investigate (1) the course of glycemic control at CD diagnosis and after the initiation of a gluten-free diet (GFD) in T1DM patients; (2) the prevalence of diabetic complications in T1DM patients with adult onset of CD. In 20 hospitals in the Netherlands, we identified T1DM patients diagnosed with CD at adult age. We retrospectively collected glycated hemoglobin (HbA1c) levels before CD diagnosis, at CD diagnosis, and the most recent HbA1c levels as well as the presence of nephropathy and retinopathy. The control group consisted of patients with T1DM and negative CD serology matched for age, gender, T1DM duration, and HbA1c levels. Thirty-one patients were eligible with a median duration of T1DM and CD of 27 years (IQR 14–37) and 3 years (IQR 1–8), respectively. The matched control group consisted of 46 patients. HbA1c levels at the moment of CD diagnosis were 7.5 % (IQR 7.1–8) [58 mmol/mol] and at the most recent visit 7.4 % (IQR 6.9–7.9, P = 0.15) [57 mmol/mol] indicating no difference. Prevalence of retinopathy was lower in T1DM + CD group compared with controls, (38.7 vs 67.4 %, P < 0.05), whereas no difference in the prevalence of nephropathy was found between the groups (P = 0.09). In conclusion, T1DM + CD patients have less retinopathy compared to T1DM patients without CD. A GFD possibly favorable affects the development of vascular complications in T1DM patients.

Access this article

Log in via an institution

Subscribe and save

  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Atkinson MA, Maclaren NK (1994) The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med 331:1428–1436

    Article  PubMed  CAS  Google Scholar 

  2. The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986

    Google Scholar 

  3. Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C, Nuber A, Pozza G, Ward JD (1996) Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM complications study. Diabetologia 39:1377–1384

    Article  PubMed  CAS  Google Scholar 

  4. Paterson AD, Rutledge BN, Cleary PA, Lachin JM, Crow RS (2007) The effect of intensive diabetes treatment on resting heart rate in type 1 diabetes: the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 30:2107–2112

    Article  PubMed  Google Scholar 

  5. Diabetes Control and Complications Trial Research Group (1994) Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: diabetes control and complications trial. J Pediatr 125:177–188

    Google Scholar 

  6. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B (2005) Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353:2643–2653

    Article  PubMed  Google Scholar 

  7. Barker JM (2006) Clinical review: type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab 91:1210–1217

    Article  PubMed  CAS  Google Scholar 

  8. Abadie V, Sollid LM, Barreiro LB, Jabri B (2011) Integration of genetic and immunological insights into a model of celiac disease pathogenesis. Annu Rev Immunol 29:493–525

    Article  PubMed  CAS  Google Scholar 

  9. Biagi F, Klersy C, Balduzzi D, Corazza GR (2010) Are we not over-estimating the prevalence of coeliac disease in the general population? Ann Med 42:557–561

    Article  PubMed  Google Scholar 

  10. Holmes GK (2001) Coeliac disease and type 1 diabetes mellitus—the case for screening. Diabet Med 18:169–177

    Article  PubMed  CAS  Google Scholar 

  11. Kaukinen K, Salmi J, Lahtela J, Siljamaki-Ojansuu U, Koivisto AM, Oksa H, Collin P (1999) No effect of gluten-free diet on the metabolic control of type 1 diabetes in patients with diabetes and celiac disease. Retrospective and controlled prospective survey. Diabetes Care 22:1747–1748

    Article  PubMed  CAS  Google Scholar 

  12. Depczynski B (2008) Coeliac disease and its relation to glycaemic control in adults with type 1 diabetes mellitus. Diabetes Res Clin Pract 79:e10

    Article  PubMed  Google Scholar 

  13. Molitch ME, Steffes MW, Cleary PA, Nathan DM (1993) Baseline analysis of renal function in the diabetes control and complications trial. The diabetes control and complications trial research group (corrected). Kidney Int 43:668–674

    Article  PubMed  CAS  Google Scholar 

  14. Leeds JS, Hopper AD, Hadjivassiliou M, Tesfaye S, Sanders DS (2011) High prevalence of microvascular complications in adults with type 1 diabetes and newly diagnosed celiac disease. Diabetes Care 34:2158–2163

    Article  PubMed  Google Scholar 

  15. Malalasekera V, Cameron F, Grixti E, Thomas MC (2009) Potential reno-protective effects of a gluten-free diet in type 1 diabetes. Diabetologia 52:798–800

    Article  PubMed  CAS  Google Scholar 

  16. Pitocco D, Giubilato S, Martini F, Zaccardi F, Pazzano V, Manto A, Cammarota G, Di SE, Pedicino D, Liuzzo G, Crea F, Ghirlanda G (2011) Combined atherogenic effects of celiac disease and type 1 diabetes mellitus. Atherosclerosis 217:531–535

    Article  PubMed  CAS  Google Scholar 

  17. Sud S, Marcon M, Assor E, Palmert MR, Daneman D, Mahmud FH (2010) Celiac disease and pediatric type 1 diabetes: diagnostic and treatment dilemmas. Int J Pediatr Endocrinol 2010:161285

    Article  PubMed  Google Scholar 

  18. American Diabetes Association (2011) Standards of medical care in diabetes—2011. Diabetes Care 34(suppl 1):S11–S61

    Google Scholar 

  19. Revised criteria for diagnosis of coeliac disease (1990) Report of working group of European society of paediatric gastroenterology and nutrition. Arch Dis Child 65:909–911

    Article  Google Scholar 

  20. Wilkinson CP, Ferris FL III, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT (2003) Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682

    Google Scholar 

  21. Picarelli A, Di TM, D’Amico T, Mercuri V, Gargiulo P (2011) Type 1 diabetes mellitus and celiac disease: endothelial dysfunction. Acta Diabetol [Epub ahead of print]

  22. West J, Logan RF, Card TR, Smith C, Hubbard R (2004) Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Aliment Pharmacol Ther 20:73–79

    Article  PubMed  CAS  Google Scholar 

  23. Skovbjerg H, Tarnow L, Locht H, Parving HH (2005) The prevalence of coeliac disease in adult Danish patients with type 1 diabetes with and without nephropathy. Diabetologia 48:1416–1417

    Article  PubMed  CAS  Google Scholar 

  24. Collin P, Kaukinen K, Valimaki M, Salmi J (2002) Endocrinological disorders and celiac disease. Endocr Rev 23:464–483

    Article  PubMed  CAS  Google Scholar 

  25. Brownlee M, Hirsch IB (2006) Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA 295:1707–1708

    Article  PubMed  CAS  Google Scholar 

  26. Rodbard D (2011) Glycemic variability: measurement and utility in clinical medicine and research-one viewpoint. Diabetes Technol Ther 13:1077–1080

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands

    Sjoerd F. Bakker, Maarten E. Tushuizen & Chris J. Mulder

  2. Department of Medical Immunology, VU University Medical Center, Amsterdam, The Netherlands

    Mary E. von Blomberg

  3. Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Suat Simsek

  4. Department of Internal Medicine, Medical Center Alkmaar, PO Box 501, 1815 JD, Alkmaar, The Netherlands

    Suat Simsek

Authors

  1. Sjoerd F. Bakker

    You can also search for this author inPubMed Google Scholar

  2. Maarten E. Tushuizen

    You can also search for this author inPubMed Google Scholar

  3. Mary E. von Blomberg

    You can also search for this author inPubMed Google Scholar

  4. Chris J. Mulder

    You can also search for this author inPubMed Google Scholar

  5. Suat Simsek

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Suat Simsek.

Additional information

Communicated by Guido Pozza.

About this article

Cite this article

Bakker, S.F., Tushuizen, M.E., von Blomberg, M.E. et al. Type 1 diabetes and celiac disease in adults: glycemic control and diabetic complications. Acta Diabetol 50, 319–324 (2013). https://doi.org/10.1007/s00592-012-0395-0

Download citation

  • Received: 20 February 2012

  • Accepted: 04 April 2012

  • Published: 27 April 2012

  • Issue Date: June 2013

  • DOI: https://doi.org/10.1007/s00592-012-0395-0

Keywords