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.
Similar content being viewed by others
References
Atkinson MA, Maclaren NK (1994) The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med 331:1428–1436
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
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
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
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
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
Barker JM (2006) Clinical review: type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab 91:1210–1217
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
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
Holmes GK (2001) Coeliac disease and type 1 diabetes mellitus—the case for screening. Diabet Med 18:169–177
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
Depczynski B (2008) Coeliac disease and its relation to glycaemic control in adults with type 1 diabetes mellitus. Diabetes Res Clin Pract 79:e10
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
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
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
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
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
American Diabetes Association (2011) Standards of medical care in diabetes—2011. Diabetes Care 34(suppl 1):S11–S61
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
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
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]
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
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
Collin P, Kaukinen K, Valimaki M, Salmi J (2002) Endocrinological disorders and celiac disease. Endocr Rev 23:464–483
Brownlee M, Hirsch IB (2006) Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA 295:1707–1708
Rodbard D (2011) Glycemic variability: measurement and utility in clinical medicine and research-one viewpoint. Diabetes Technol Ther 13:1077–1080
Author information
Authors and Affiliations
Corresponding author
Additional information
Communicated by Guido Pozza.
Rights and permissions
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00592-012-0395-0