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.
The 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.
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.