Celiac.com 08/03/2015 - Patients with type 1 diabetes who have celiac disease face in increased risk for retinopathy and nephropathy. A team of researchers recently set out to investigate whether celiac disease associated with type 1 diabetes increases the risk of microvascular complications.

Kids at playground. Photo: CC: Eden, Janine and JimThe research team included T.R. Rohrer, J. Wolf, S. Liptay, K.P. Zimmer, E. Fröhlich-Reiterer, N. Scheuing, W. Marg, M. Stern, T.M. Kapellen, B.P. Hauffa, J. Wölfle, R.W. Holl; and the DPV Initiative and the German BMBF Competence Network Diabetes Mellitus.

They are variously affiliated with the Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany,the Department of Pediatric and Adolescent Medicine, St. Vincenz Hospital, Paderborn, Germany, the Department of Pediatrics, Technical University Munich, Munich, Germany, the Department of General Pediatrics and Neonatology, Children's Hospital, University of Giessen, Giessen, Germany, the Department of Pediatrics, Medical University of Graz, Graz, Austria, the Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany, the Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany, the University of Tübingen Children's Hospital, Tübingen, Germany, the Department of Pediatrics, University of Leipzig, Leipzig, Germany, the Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University of Duisburg-Essen, Essen, Germany, and with the Pediatric Endocrinology Division of the Children's Hospital at the University of Bonn in Bonn, Germany.

Their team conducted a multi-center longitudinal analysis of 56,514 patients from the German-Austrian DPV database. Patients were over 10 years of age, with diabetes for less than 20 years from 392 centers in Germany and Austria.

Patients were assigned to one of three categories (n): no celiac disease (50,933), biopsy-confirmed celiac disease (812), or suspected celiac disease (4,769; clinical diagnosis or positive antibodies).

The team combined the confirmed and suspected groups, and analyzed them for retinopathy or nephropathy. The team used Cox proportional hazards regression to adjust for potential confounders, such as glycated hemoglobin [HbA1c], age at diabetes onset, sex, smoking, dyslipidemia, and hypertension.

Kaplan-Meier analysis showed that retinopathy and nephropathy occurred earlier in the presence versus absence of celiac disease:

The team found retinopathy at age 26.7 years (95% CI 23.7-30.2) in 25% of patients with celiac disease vs. age 33.7 years (33.2-34.4) in 25% without celiac disease. They also found micro-albuminuria at age 32.8 years (29.7-42.5) vs. 42.4 years (41.4-43.3).

Compared to versus patients without celiac disease, patients with diabetes and celiac disease showed higher adjusted risk for both retinopathy (hazard ratio 1.263 [95% CI 1.078-1.481]) and nephropathy (1.359 [1.228-1.504]).

Cox regression showed that celiac disease is an independent risk factor for microvascular complications after adjustment for confounders.

Patients with type 1 diabetes who have celiac disease face in increased risk for retinopathy and nephropathy, and the team recommends regular serologic celiac disease testing for type 1 patients, even in the absence of clinical celiac disease.

Additional prospective studies are needed to determine whether a gluten-free diet might lower the risk of microvascular disorders in patients with both diabetes and celiac disease.

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