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  • Jefferson Adams
    Jefferson Adams

    Celiac Autoimmunity in Type I Diabetes Mellitus

    Reviewed and edited by a celiac disease expert.

    Celiac.com 02/10/2015 - A number of studies have shown a connection between celiac autoimmunity and type 1 diabetes mellitus (T1DM). Doctors recommend celiac screening for T1DM patients, but screening is not always conducted.

    Photo: CC--Heather AitkenMeanwhile, reports about the impact of celiac autoimmunity in T1DM have been varied. A team of researchers recently set out to determine rates of celiac autoimmunity in patients with T1DM, and to study the impact of celiac autoimmunity on nutritional parameters, glycaemic control, endocrine axes and bone health.



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    The research team included A.S. Joshi, P.K. Varthakavi, N.M. Bhagwat, M.D. Chadha, AND S.S. Mittal. They are variously associated with the Department of Endocrinology of Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central in Maharashtra, India.

    For their study, the team conducted celiac autoimmunity screens on eighty-six consecutive patients with T1DM using immunoglobulin A (IgA) tissue transglutaminase as a marker (TTG; IgG anti-gliadin in IgA-deficient case). They compared CA positive (CA+) T1DM cases with age-matched and sex-matched CA negative (CA-) T1DM cases for anthropometry, glycaemic control (as assessed by glycated haemoglobin (HbA1c) and hypoglycaemic/hyperglycaemic episodes), endocrine (thyroid function, cortisol, growth hormone (GH) axis, gonadal axes), haematological (haemoglobin, iron profile and vitamin B12 status) and calcium metabolism parameters and bone densitometry (by dual-energy X-ray absorptiometry (DXA)).

    Consenting patients with celiac autoimmunity also underwent upper gastrointestinal (GI) endoscopy with duodenal biopsy.

    Results showed that 11 of the 86 patients, about 12.75%, screened positive for celiac autoimmunity. Of those, seven patients underwent duodenal biopsies which suggested two cases of Marsh grade III, three cases of Marsh grade II and two cases of Marsh grade I celiac disease.

    In terms of anthropometry, CA+ T1DM patients were comparable with CA- T1DM patients. Overall, CA+ patients had higher HbA1c (10.7±1.8 vs. 8.4±1.0 (93±19 vs. 68±11 mmol/mol); p

    The incidence of fractures in the past 3 years was four CA+ patients, and one CA- patient (p<0.05).

    There is an important autoimmune connection between celiac disease and T1DM. For people with T1DM, celiac disease adversely affects stature, bone health, glycaemic control and iron and B12 levels.

    The study team recommends that IgA sufficiency be established before using an IgA-based screening test for celiac autoimmunity.

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    My son was diagnosed with type 1 at 12 months old. At 12 years old after years of trying to figure out why he stopped growing on the growth chart, he was finally diagnosed with celiac. He had complete atrophy of the villi. The first year gluten free he grew 6 inches and gained 20 pounds. The good news is he's a college athlete today and as healthy and happy as ever. These diagnosiss don't mean the end of a great quality of life

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    You may add me to the list of being diabetic 45 years and 1 1/2 years with celiac disease. Thank you for posting this connection of the 2 autoimmune disease, so maybe doctors will start testing for celiac when they see the person with diabetes having gut issues instead of treating for spastic colon and irritable bowel with medicine for years. THANK YOU

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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  • Related Articles

    Scott Adams
    Arch Dis Child 2004;89:871-876. Celiac.com 07/12/2005 – Australian researchers have determined that a gluten-free diet in children with Type 1 diabetes mellitus and celiac disease can improve both growth and diabetes control. In the study 21 children (mean age 7.5 years) with both conditions went on a gluten-free diet for 12 months, and their growth and insulin dosages were carefully measured and compared with that of two matched diabetic, non-celiac controls. The group on a gluten-free diet showed significant increases in weight and body mass index compared with the control group, although an increase in height found in the study was not found to be significant. At the time of diagnosis insulin dosages for the celiac disease group were less than that of the control group, but became similar to the controls once a gluten-free diet was started—although the increase in insulin dosage had no effect on HbA1c levels.
    The researchers conclude: “Identification and dietary treatment of celiac disease in children with diabetes improved growth and influenced diabetic control. Evaluation of the outcome of treatment of celiac disease in diabetics should include assessments of gluten intake.” Obviously all children (and everyone) with celiac disease should be on a gluten-free diet, but what is noteworthy about this study is that a connection was found between insulin levels, diabetes control, and the gluten-free diet.


    Jefferson Adams
    Celiac.com 09/24/2009 - Could a reduced level of antibodies against infectious agents indicate a protective role for such infections in T1DM development in susceptible individuals? Recent research points in that direction. Type 1 diabetes mellitus (T1DM) is an autoimmune disease with intricate and poorly understood associations between genetic and environmental factors.
    A joint Israeli-Colombian research team recently set out to examine the connections between anti-infectious antibodies and autoimmune-associated autoantibodies in patients with Type I diabetes mellitus and their close family members. Among other things, their findings confirmed a strong association between celiac disease and Type 1 diabetes mellitus.
    The research team was made up of Ilan Krause, Juan Manuel Anaya, Abigail Fraser, Ori Barzilai, Maya Ram, Verónica Abad, Alvaro Arango, Jorge García, and Yehuda Shoenfeld. The team compared levels of antibodies to numerous infectious agents and of autoimmune-associated antibodies between Colombian T1DM patients, their close family members and healthy control subjects.
    T1DM patients showed substantially reduced levels of antibodies against several infectious agents, including: cytomegalovirus (P= 0.001); Epstein-Barr virus (P= 0.02); Helicobacter pylori (P= 0.01); and Toxoplasma (P= 0.001).
    T1DM patients showed markedly elevated levels of IgG-anti-gliadin antibodies (P= 0.001) and IgG-antitissue transglutaminase antibodies (P= 0.03), and a marginal connection with anti-centromere antibodies (P= 0.06).
    T1DM patients also showed a reduced level of antibodies against infectious agents that may be associated with their younger ages, but could also indicate a protective role for such infections in T1DM development in susceptible individuals.
    The results reinforce the connection between T1DM and celiac disease, though the
    possible connection with the anti-centromere antibody requires a deeper examination.
    Studies like this are important to help build a record of all of the points of contact between these associated conditions so we can begin to understand the intricate web that ties these conditions together, and inch toward the deeper causes that lie at the heart of the mystery of celiac disease, diabetes, and so many other auto-immune/inflammatory disorders.
    Source:
    Annals of the New York Academy of Sciences - Volume 1173 Issue Contemporary Challenges in Autoimmunity, Pages 633 - 639



    Jefferson Adams
    Celiac.com 08/20/2012 - People with Type 1 Diabetes (T1D) suffer from celiac disease at rates ranging from 4.4 to 11.1%, compared with rates of 0.5% for the general population.
    The reason for this connection is due at least in part to the fact that the HLA genotypes DR3-DQ2 and DR4-DQ8 are strongly associated with T1D, while DR3-DQ2 is associated with celiac disease.
    To get a better sense of the issue, a research team recently assessed celiac disease in type 1 diabetes mellitus.
    The research team included Maria Erminia Camarca, Enza Mozzillo, Rosa Nugnes, Eugenio Zito, Mariateresa Falco, Valentina Fattorusso, Sara Mobilia, Pietro Buono, Giuliana Valerio, Riccardo Troncone, and Adriana Franzese.
    The are variously affiliated with the Department of Paediatrics, "Federico II" University, the School of Movement Sciences (DiSIST) at Parthenope University, and the Department of Cellular and Molecular Pathology "L. Califano", "Federico II" University, all in Naples, Italy.
    People with T1D rarely show classical severe symptoms of celiac disease. Usually, they have few or mild symptoms of celiac disease, or show no symptoms at all (silent celiac disease).
    In fact for T1D patients, diagnosis of celiac disease is usually done by blood screening.
    The effects of gluten-free diet (GFD) on the growth and T1D metabolic control in celiac disease/T1D patient are controversial.
    There is some debate about whether gluten-free foods have a higher glycemic index compared with to gluten-containing foods; and also about whether gluten-free foods might be be lower in fiber and higher in fat.
    Adherence to a gluten-free diet by children with celiac disease-T1D has generally been reported at below 50%, compared with about 73% for those with celiac disease alone. Failure to follow a gluten-free diet is even more common among asymptomatic patients.
    The more severe problems of gluten-free diet adherence usually occur during adolescence when non-compliant subjects report the lowest quality of life.
    The researchers suggest providing psychological and educational support for these patients.
    Source:
    Ital J Pediatr. 2012; 38: 10. doi: 10.1186/1824-7288-38-10


    Jefferson Adams
    Celiac.com 12/25/2012 - The connection between celiac disease and type 1 diabetes mellitus is well known. Up to now, very little has been reported about rates of celiac disease in children and adults with type 1 diabetes in Sicily.
    A team of researchers recently set out to assess the prevalence of celiac disease in patients with type 1 diabetes mellitus who come from a specific region of western Sicily and to assess the clinical features of these patients.
    The research team included D. Greco, M. Pisciotta, F. Gambina, and F. Maggio of the Division of Diabetology at Paolo Borsellino Hospital in Marsala, Italy.
    For their study, they analyzed data from 492 consecutive patients with type 1 diabetes mellitus who were referred over a five year period.
    They found that, of the 492 patients with type 1 diabetes, 14 females and eight males (a total of 4.5%) suffered from celiac disease. The patients averaged thirteen years of age at the time of diabetes onset.
    The team found that patients were diagnoses with celiac disease either at about the same time as diabetes, or afterward. They found that eight patients (36%) had coexisting autoimmune thyroiditis.
    Their data show that, within this Sicilian population, the association between celiac disease and type 1 diabetes is common, though at lower rates than in other studies of the Italian population. They also found high rates of autoimmune thyroiditis in these patients.
    They also noted that celiac disease diagnosis often followed onset of type 1 diabetes, especially in females whose diabetes began at an early age. They conclude that this finding warrants an active search for the celiac disease for many years after the onset of diabetes.

    Source:
    Endocrine. 2012 Jun 16.


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