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The Celiac Disease and Type 1 Diabetes Screening Controversy
I diagnosed myself for gluten intolerance after a lifetime of bizarre, seemingly unrelated afflictions. If my doctors had their way, I would have already undergone neck surgery, still be on 3 different inhalers for asthma, be vomiting daily and having chronic panic attacks. However, since eliminating gluten from my diet in May 2009, I no longer suffer from any of those things. Even with the proof in the pudding (or gluten) my doctors now want me to ingest gluten to test for celiac-no can do.View all articles by Destiny Stone
To screen or not to screen diebetics for celiac disease?
Celiac.com 08/09/2010 - Modern scientists agree that scientific evidence connects celiac disease with Type 1 Diabetes. What scientists fail to agree on is what to do about the connection between the two autoimmune diseases. Some scientists promote celiac screening for all patients with type 1 Diabetes, while other scientists disagree.
Celiac disease and Type 1 Diabetes are similar in that they are both autoimmune disorders resulting from a combination of genetic predisposition and environmental factors. The occurrence of celiac disease in patients with Type 1 Diabetes is documented to have a ratio 5-7 times higher than the general public. Also noted is an increased prevalence rate within ethnic groups.
Classic celiac disease symptoms can be seen in Type 1 Diabetes patients, although most celiac and Type 1 diabetics are found to have mild or no symptoms. In fact, a study at a North American celiac clinic examined children that had celiac and Type 1 Diabetes and showed that 71.4% of the subjects claimed to have no gastrointestinal symptoms at the time of their positive diagnosis.
Another similar study in the United Kingdom reported that 76.4% of their patients studied exhibited at least one gastrointestinal symptom. In fact, the study goes on to state that when they further examined the Type 1 diabetics, 86% initially showed no symptoms but at the time of biopsy the percentage dropped to 22%.
Serological testing has not only improved screening methods for celiac diagnosis, but also let to an increase in celiac diagnosis rates. In Canada for example, celiac disease prevalence has shown a threefold increase since 1996. Consensus-based celiac testing guidelines have been developed by many organizations, however, all of these organizations have a different idea of what to recommend to Type 1 diabetics when it comes to celiac screening and treatments.
The North American Society for Pediatric Gastroenterology and Hepatology (NASPGHAN) suggests screening all Type 1 Diabetes patients for celiac disease and they encourage a gluten-free diet for asymptomatic children with other associated conditions. However HASPGHAN also recognizes that there isn't a lot of evidence supporting short-term improvements for diabetics on a gluten-free diet.
The International Society for Pediatric and Adolescent Diabetes (ISPAD) agrees that there is limited data to support a gluten-free diet for diabetics. As such ISPAD refers children to a pediatric dietician if they test positive for celiac disease and Type 1 Diabetes.
The National Institutes of Health promotes celiac screening for symptomatic Type 1 Diabetes patients, and they recommend treating patients that exhibit biopsy proven celiac disease.
The American Diabetic Association (ADA) advocates screening all Type 1 Diabetes patients for celiac. They also urge patients with a confirmed celiac diagnosis to maintain a gluten-free diet.
The Canadian Diabetes Association (CDA) promotes screening Type 1 Diabetes patients for celiac but they emphasize that treatment of asymptomatic celiac disease combined with Type 1 Diabetes is
These conflicting instructions for screening and treating celiac are partly to blame the fact that most physicians are unclear about proper protocol for celiac diagnosis and treatment. With so many authorities offering conflicting advice, it's no wonder that many celiacs remain misdiagnosed or undiagnosed. It is also further evidence that a mandated approach to detecting and treating celiac disease is critical in order to avoid long term ramifications.
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