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.

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Celiac.com 11/21/2011 - Celiac disease is common in people with type 1 diabetes (T1D). These people can show Abs reactions against tissue transglutaminase, the prime trigger in celiac disease. In short, gliadin seems to play a role in type 1 diabetes pathogenesis.

An international research team set out to investigate whether gliadin contributes to enteropathy and insulitis in NOD-DQ8 mice, an animal model that does not spontaneously develop T1D.

The researchers included Heather J. Galipeau, Nestor E. Rulli, Jennifer Jury, Xianxi Huang, Romina Araya, Joseph A. Murray, Chella S. David, Fernando G. Chirdo, Kathy D. McCoy, and Elena F. Verdu, and are variously affiliated with the Farncombe Family Digestive Health Research Institute at McMaster University Medical Centre in Canada, Laboratorio de Investigación en el Sistema Inmune, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina, the Department of Internal Medicine, and the Department of Immunology at the Mayo Clinic College of Medicine in Rochester, MN, and with the Department of Clinical Research, University of Bern, Bern, Switzerland.

Researchers know that gliadin-sensitized NOD-DQ8 mice develop moderate enteropathy, intraepithelial lymphocytosis, and barrier dysfunction, but do not develop insulitis. The team administered anti-CD25 mAbs before gliadin-sensitization induced partial depletion of CD25+Foxp3+ T cells, which triggered severe insulitis, but did not worsen mucosal dysfunction.

The team isolated CD4+ T cells isolated from pancreatic lymph nodes. Those from mice that developed insulitis showed higher proliferation and pro-inflammatory cytokines after incubation with gliadin, but not with BSA. CD4+ T cells isolated from non-sensitized control mice showed no response to gliadin or BSA.

From these observations, the team concluded that gliadin sensitization triggered moderate enteropathy in NOD-DQ8 mice. However, triggering insulitis required gliadin-sensitization and partial systemic depletion of CD25+Foxp3+ T cells.

This study offers a model for explaining how mucosal intolerance to a dietary protein can trigger insulitis as a result of partial regulatory T cell deficiency.

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Celiac.com 07/22/2011 - Many reports indicate a hypercoagulative state in diabetes mellitus as result of endothelial damage. Numerous researchers have reported a strong association between type 1 diabetes mellitus (DM1) and celiac disease.

Clinical data indicate that vascular dysfunction can result from a cascade of biochemical events triggered by a metabolic malfunction. The net result changes the cells that line the interior surface of the blood vessels; from a surface called a thrombo-resistant surface to one called a thrombo-genic surface.

A research team recently set out to determine whether celiac disease in a group of DM1 patients is connected with a different expression of certain hemostatic factors, and with a different manifestation and/or progression of microvascular complications of DM1, as compared to patients with diabetes alone.

For the study, the team enrolled ninety-four adult patients with DM1, who they then screened for celiac disease. They found anti-endomysial antibodies (EMA) in 13 of 94 DM1 patients (13.8%). The team then confirmed celiac disease diagnosis by histology and organ culture.

The mean age and duration of DM1 of patients also affected by celiac disease were similar to those patients with diabetes alone, but the groups showed very different parameters for metabolic control and hemo-coagulation. In DM1 patients with celiac disease those parameters include:

• Signiï¬cantly lower concentrations of glycosylated hemoglobin (HbA1c) (P.05), cholesterol (P.001), triglycerides (P.001), factor VII antigen (FVII:ag) (P.005), factor VII coagulant activity (FVII:c) (P.05), and prothrombin degradation fragments (F1+2) (P.001).
• Higher values of activated C protein (APC) (.001).
  

The results suggest a potential protective role of celiac disease in the pro-thrombotic state of DM1.

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The research team included Sandra Hummel, PHD, Maren Pflüger, PHD, Michael Hummel, MD, Ezio Bonifacio, PHD, and Anette-G. Ziegler, MD.

They are variously affiliated with the Institute for Diabetes Research, Helmholtz Zentrum München, Forschergruppe Diabetes der Technischen Universität München, the Institut für Diabetesforschung der Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany, and the Deutsche Forschungsgemeinschaft Center for Regenerative Therapies Dresden, Technische Universität Dresden, Germany.

For the study, the team recruited a total of 150 infants with a first-degree family history of type 1 diabetes and a risk HLA genotype.

They then randomly assigned each infant to a first gluten exposure at age 6 months (control group) or 12 months (late-exposure group).

The team followed-up on each infant at three month-intervals until the age of 3 years, and then yearly thereafter. The team tested for growth and autoantibodies to transglutaminase C [TGCAs]), islet autoantibodies to insulin, GAD, insulinoma-associated protein 2, and type 1 diabetes.

A total of 70% of families reported following the  dietary-intervention protocol. For the first three years, children in the control and late-exposure groups showed similar weight and height, along with similar probability of developing TGCAs (14 vs. 4%; P = 0.1).

A total of eleven children in the control group and 13 children in the late-exposure group developed islet autoantibodies (3-year risk: 12 vs. 13%; P = 0.6).

Seven children developed diabetes, including four in the late-exposure group. The team saw no significant differences when analyzing children as per protocol on the basis of the first reported reported gluten exposures for the children.

From the data, the team concluded that delaying gluten exposure until the age of 12 months is safe, but does not significantly reduce the likelihood of islet autoimmunity in genetically at-risk children.

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Celiac.com 11/03/2010 - Children who have both type 1 diabetes and celiac disease, and who also delay a gluten-free diet are about as healthy as kids with type 1 diabetes alone, according to a report in the Journal of Pediatrics.

A two year prospective longitudinal review comparing factors including glycemic control, celiac symptoms, or z-scores for weight, body mass index, or height found no significant differences between children who eat a gluten free diet and children who eat to a regular diet.

About one of every eight children with type 1 diabetes also suffers from celiac disease.

However, this high rate was noted after the development of blood screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibody (TG); a TG index > 0.05 is considered positive. Currently, doctors don't fully understand the implications of a positive TG index in the absence of symptoms.

Whether or not to screen diabetic kids for celiac disease remains controversial. Numerous pediatric diabetes and gastroenterology associations currently recommend screening diabetic kids for celiac disease, while the National Institutes of Health consensus statement does not recommend such screening.

Dr. Jill H. Simmons, from Vanderbilt Children's Hospital, Nashville, Tennessee, led a team of researchers that examined the natural history of celiac autoimmunity in children with type 1 diabetes, and explored the benefit of an early gluten-free diet.

For the study, the team compared 79 diabetic children with celiac disease antibodies and 56 diabetic children without celiac disease who averaged 10 years old, duration of diabetes (4 years) and gender (56% male).

Of the 79 children with positive TG tests, 36 continued eating a regular diet, while 43 followed a gluten-free diet.

The team was logistically unable to conduct a two-year follow-up on all participants, and ultimately analyzed complete results for 26 gluten-eating kids, and 37 following a gluten-free diet.

Even though the gluten-free diet group showed a higher TG index at the start of the study (0.66 vs. 0.45, p = 0.03), the two groups evened out after 24 months (0.31 vs. 0.35).

The groups had about the same overall HbA1c, with the gluten-free group coming in at 8.1% compared with 8.2% for the regular diet group.

The team found that 16.2% of gluten-free kids experienced episodes of severe hypoglycemia, compared to 8% of the kids who ate gluten, but the difference was not statistically significant.

One year into the study, percentages of patients reporting celiac-associated symptoms, such as diarrhea, abdominal pain, constipation, and abdominal distention were 71% in the gluten-free group, compared with 58% with the gluten-free diet vs. 71%). However, by the two-year mark, these numbers had also evened out. This is interesting, because both groups still report what seem like relatively high rates of celiac-associated symptoms.

One important difference at two-year mark was insulin-like growth factor binding protein 3 z-score (-0.23 vs. -1.16, p = 0.002).

Therefore, the team concludes, this study "did not demonstrate significant adverse outcome in those children who delayed" a gluten-free diet.

Dr. Simmons' group also compared characteristics between TG-positive and -negative children. At baseline, TG-positive subjects had lower z-scores for weight and mid-arm circumference, lower free T4 and insulin/kg values, higher intact parathyroid hormone level, and higher urinary cross-linked N-telopeptides of type 1 collagen (NTX).

After 2 years, the only remaining differences were higher urinary NTX and lower weight and BMI z-scores. TG status had no influence on glycemic control.

Whatever the case, due to the study's small size, and numerous other factors, the question of whether to screen diabetic children for celiac disease, and how soon to start them on a gluten-free diet, remains unanswered.

Also, focus of the study seems a it off the mark. The study does not seem to address the basic complications of celiac disease in general. Rather, it looks at celiac disease purely through the lens of whether or not there are substantial physiological differences in diabetic children with celiac disease who eat gluten-free versus those who do not; or in those who delay the diet versus those who begin immediately.

A better question to examine might be: At what point does the damage from celiac disease begin to occur in children with celiac disease who continue to eat a diet that includes gluten?

We know the damage from untreated celiac disease starts at some point, and is cumulative in its effect. Clearly, at some point a gluten-free diet will be necessary for diabetic children with celiac disease, so what advantage is there to not putting the child on a gluten-free diet as soon as possible?

To their credit, the research team notes that further research is needed to determine the optimal timing of celiac screening in diabetic children, and how soon to begin treatment with a gluten-free diet, weighing cost vs. benefits and effects on quality of life.

However, they don't have much to say about what quality of life issues for untreated celiac disease. The team does not examine any aspect of behavioral changes or improvements that may occur when gluten is eliminated; or other factors. They do not address the fact that celiac disease is an auto-immune disease, or the wisdom of permitting an auto-immune disease that is so easily treated as celiac disease to go untreated while trying to treat diabetes.

I would say take this study with a grain of salt and keep an eye out for more studies that further elucidate the associations between diabetes and celiac disease, and which provide clearer answers to the question of how soon diabetic children with celiac disease should begin a gluten-free diet.

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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
controversial.

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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Celiac.com 07/07/2010 - There is mounting evidence that people with Type 1 diabetes are at high risk for celiac disease. Even with that knowledge, it is estimated that 97% of people with celiac disease go undiagnosed, which begs the question,  "should there be routine screening for celiac disease in those with type 1 diabetes?" Dr. Speiser and Dr. Rosenzweig explore the question  the further.

Doctor Phyllis Speiser, Chief of the Division of Pediatric Endocrinology at North Shore-Long Island Jewish Health System in New Hyde Park, New York explains her stance in an interview with Medscape Diabetes and Endocrinology. Doctor Speiser notes that even at her institution there is a vast spectrum of varying opinions among pediatric endocrinologists regarding when and how to screen for celiac. Dr. Speiser believes that more awareness of celiac disease needs to occur, especially pertaining to atypical celiac patients, or those that do not exhibit any obvious signs of celiac disease.

According to Dr. Speiser, research has shown that the prevalence of  celiac disease in patients with diabetes (both autoimmune diseases) is considerably higher, from 1%-16%, compared to the general population, from 0.3% to 1%. Moreover, when undiagnosed celiac disease can lead to secondary complications, including; stunted growth, weight loss, and bowl malignancy.

Dr. Speiser and her coauthors studied the medical records of 532 consecutive patients with type 1 diabetes who were evaluated at some point between over a 3 year period by the Pediatric endocrinology division of her institution.

Within 3 months of receiving a type 1 diabetes diagnosis, 493 patients were screened for celiac disease. Upon initial testing,  5.1% the patients with Type 1 diabetes were seropositive for celiac disease. Of those 11 patients, 44% were shown to have biopsy proven celiac disease. Of the other 94.9% of the subjects that tested seronegative for celiac on their initial screening, 5.4% were given a second screening. After being diagnosed with type 1 diabetes at least 5 years prior,  one of those patients  had biopsy-proven celiac disease.

Twelve of the type 1 diabetic patients that had biopsy-proven celiac disease were placed on a gluten-free diet. It is interesting to note,  that approximately 58% of the patients with biopsy proven celiac, had been diagnosed for longer than a year, and up to 10 years after their type 1 diabetes diagnosis.

Additionally, there were no reports from type 1 diabetic patients with biopsy-proven celiac disease reported gastrointestinal symptoms prior to receiving a  confirmed celiac disease diagnosis. Dr. Speiser emphasized the importance of early screening stating that this finding  “underscores the importance of not delaying screening for celiac disease until overt GI symptoms present”. Furthermore, based on her study, Dr. Speiser recommends screening for celiac disease as soon as a patient is positively diagnosed with diabetes.

Dr. Speiser further stresses the importance of frequency in testing for celiac in diabetic patients. According to Dr. Speiser, some patients don't develop celiac for many years after receiving a diabetes diagnosis. Therefor, Dr. Speiser  recommends celiac screening once a year for patients with diabetes. Dr. Speiser notes that while celiac disease is often asymptomatic, symptomatic hypoglycemia often occurs in type 1 diabetic patients withing 6 months of receiving a positive celiac diagnosis.

Doctor James L. Rosenzweig, an endocrinologist and associate professor of medicine at Boston University School of Medicine in Massachusetts, confirms that there is a well-known connection between type 1 diabetes and celiac however, he believes more studies are needed before he is convinced that more celiac screenings for pediatric diabetics.  are necessary.  Dr. Rosenzweig said in his interview that more tests require more money, and the cost of screening for celiac can really add up.

While screenings for celiac may be expensive, the cost of medical bills for secondary medical problems as a result of undiagnosed celiac disease can be exorbitant, and possibly life threatening. At this juncture however, it is still a patients responsibility to  advocate for themselves where celiac screenings are involved.

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Hansson explained that researchers detected elevated levels of celiac disease-associated antibodies in children with recent onset Type I diabetes.

“The presence of autoantibodies against tissue transglutaminase (anti-tTG) implies that celiac disease was present already at the time of Type 1 diabetes onset in all children having both diseases,” he said. “Hence, celiac disease may precede and cause Type 1 diabetes in children with both diseases.”

A team of researchers looked for anti-tTG in blood samples from 169 children with new-onset Type 1 diabetes, 88 siblings of the patients, and 96 age- and gender-matched controls.

A total of 21 patients with Type 1 diabetes, six siblings, and three controls showed elevated levels of anti-tTG.

The team confirmed celiac disease via intestinal biopsy in five children before Type 1 diabetes, and 12 children after onset. Interestingly, blood samples from all but one of the 12 showed elevated anti-tTG at time of Type 1 diabetes onset and the remaining child showed elevated levels within 6 months of onset.

From this, the research team concludes that 10.1% of children with Type 1 diabetes patients showed confirmed celiac disease, compared with 4.5% of siblings, all of whom were asymptomatic, and 2.1% of controls.

The researchers suggest that a "change in diet in individuals with genetic susceptibility may reduce the risk of developing Type 1 diabetes." They add that “all Type 1 diabetes children and their siblings should be routinely screened for celiac disease-related antibodies.”

Source: Gastro 2009, UEGW/WCOG; London, UK: 21–25 November

A research team led by Dr. Fraser Scott recently screened 42 patients with type 1 diabetes and found that nearly half showed an abnormal immune response to wheat proteins.

Dr. Scott is a Senior Scientist at the Ottawa Hospital Research Institute and Professor of Medicine at the University of Ottawa. The research team includes Dr. Majid Mojibian, Dr. Habiba Chakir, Dr. David E. Lefebvre, Jennifer A. Crookshank, Brigitte Sonier and Dr. Erin Keely. 

In most people, the immune system functions normally, identifying and attacking dangerous foreign visitors, like viruses and bacteria, without harming healthy body tissue or other benign molecules, including food molecules in the digestive tract.

The breakdown of this process contributes to the development of various autoimmune diseases and allergies. In the case of Type 1 diabetes, the immune system wrongly targets the cells of the pancreas, the organ responsible for regulation of blood sugar.

Globally, diabetes afflicts nearly 250 million people. Type 1 diabetes, the most severe form of the disease, makes up about 10 percent, or about 25 million, of that worldwide total. There is currently no cure for Type 1 diabetes, and sufferers require daily insulin injections can help control blood sugar levels.

Dr. Scott’s results offer the first suggestions that T cells in the immune systems of type 1 diabetics are also more likely to have adverse immune reactions to wheat. His results also suggest that such over-reaction is tied to genes associated with type 1 diabetes.

According to Dr. Scott, the research suggests that "people with certain genes may be more likely to develop an over-reaction to wheat and possibly other foods in the gut and this may tip the balance with the immune system and make the body more likely to develop other immune problems, such as type 1 diabetes.”

Dr. Scott adds that the immune system has to find "the perfect balance to defend the bodyagainst foreign invaders without hurting itself or over-reacting to theenvironment and this can be particularly challenging in the gut, wherethere is an abundance of food and bacteria.”

In side comments that accompany the paper, diabetes expert Dr. Mikael Knip of Finland suggest that the team's results "add to the accumulating concept that the gut is an active player in the diabetes disease process.”

Earlier animal models studies by Dr. Scott have shown that a wheat-free diet can reduce the risk of developing diabetes, but he notes that more research is needed to confirm the association and to assess possible effects of diet changes in humans.

More research is also needed to examine possible connections to celiac disease, an autoimmune disease associated with adverse immune reactions to wheat proteins that has significant associations with diabetes.

This research project was funded by the Juvenile Diabetes Research Foundation and the Canadian Institutes of Health Research.

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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.

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In a recent study of 42 Ottawa-area young adults with Type 1 diabetes researchers analyzed white blood cells, looking for a response to partially-digested wheat proteins. They found that people with certain genes are more likely to develop an over-reaction to wheat in the gut. Type 1 diabetes occurs when the immune system attacks the pancreas, the organ that regulates blood sugar. No such response was seen in another 22 diabetics in the study, nor in a separate control group of non-diabetics.

The gastrointestinal tract is home to the largest variety of immune cells in the human body. In healthy people, the presence of food molecules in the gut does not spark an immune response against food molecules, Scott said. However, if the normal process breaks down, the gut can become inflamed or damaged. Celiac disease is one example of such a breakdown. Folks with Type 1 diabetes suffer higher rates of celiac disease than non-diabetics.

One hypothesis for this is that certain immune cells may be stimulated by food triggers and migrate to the pancreas, where they damage insulin-producing cells, Scott said. The human gut is one of the main places where the human body interacts with its environment, including food, chemicals, bacteria and toxins. “It important to understand the role the gastrointestinal tract plays in this disease and other autoimmune diseases,” says Scott. “There are probably a large number of people who have diabetes risk genes, but only a small proportion of them develop Type 1 diabetes. These people have difficulty handling what is present in the environment.”

Previous research has shown a gluten-free diet to reduce rates of diabetes in animal models. However, that does not mean that parents who want to keep their children from developing diabetes should adopt a gluten-free diet, says Scott. The genetic risk for diabetes is very complex, he adds.

First, it's not easy to know for certain who will contract diabetes; 9 out of 10 people who develop Type 1 diabetes don’t have a relative with Type 1, Scott said. In the mean time, the Ottawa study touches on a very important part of the diabetes mystery. A number of scientists have suspected a link between diet, the gut and Type 1 diabetes for about 20 years now, Scott said. This is one of the first studies to affirm this connection in human cells.

For Scott, the fact that 22 diabetics in the Ottawa study did not show a reaction to wheat protein means only that the condition is far more complicated than clinicians can conceive at present.

In theory, there are myriad ways in which people may come to develop diabetes, and, says Scott, each may have developed by a separate route.

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Dr. Giuseppe D'Annunzio, of the University of Genoa, and colleagues recently set out to determine which pediatric celiac patients might warrant beta-cell autoimmunity screening. His research team assessed 188 children who received celiac disease diagnosis at an average age of 5.8 years, and who had had the disease for 4.2 years on average.

The doctors confirmed gluten-free diet compliance by testing for anti-endomysial antibodies and endomysial tissue transglutaminase antibodies.

Nine of the children (4.8%) tested positive for diabetes-related auto-antibodies. However, all of these children showed normal fasting blood glucose and A1C levels and, after 36 months of follow-up, none developed type 1-diabetes.

The researchers note that there is, between celiac disease and juvenile diabetes, a shared prodromic stage, with “auto-antibodies to islet or gut antigens.” Still, they note that their findings support those of other investigators, and that routine screening for diabetes-related antibodies in children with celiac disease is not warranted.

Diabetes Care 2009; 32:254-256.