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Celiac.com 12/23/2024 - Celiac disease is an autoimmune disorder that affects the small intestine, making it difficult for the body to absorb essential nutrients. This condition can occur globally, especially in individuals with other autoimmune diseases like Type 1 diabetes. In West Africa, however, there has been little research on celiac disease’s prevalence in populations with Type 1 diabetes, which prompted this study to investigate its occurrence among Nigerian children and adolescents with diabetes. Study Objectives and Design The study aimed to explore how frequently celiac disease autoimmunity occurs in Nigerian children and adolescents diagnosed with Type 1 diabetes. Researchers examined over 100 young patients from pediatric endocrinology clinics across Nigeria, gathering data on socio-demographic factors and clinical details like symptom history and overall health. To detect celiac disease autoimmunity, the study screened for specific antibodies in blood samples. Those with elevated antibody levels were encouraged to undergo an endoscopy and a biopsy to confirm a celiac disease diagnosis. Key Findings on Celiac Disease Autoimmunity Among the participants with Type 1 diabetes, around 6% showed signs of celiac disease autoimmunity based on elevated antibody levels. All cases occurred in females, primarily between ages 3 and 12. Most of the affected children experienced gastrointestinal symptoms, including nausea, vomiting, diarrhea, and bloating, which are typical symptoms of celiac disease. A notable finding was that children diagnosed with Type 1 diabetes before age 10 were more likely to have celiac disease autoimmunity compared to those diagnosed later. Regional and Gender-Based Patterns This study highlighted potential regional trends, finding that most children with celiac disease autoimmunity were from northern Nigeria, which borders regions in North Africa where celiac disease is more prevalent. This geographical proximity may play a role in increased autoimmune conditions due to genetic similarities and environmental factors. Additionally, the study confirmed that celiac disease autoimmunity appears more frequently in females, consistent with broader findings in autoimmune research. Challenges and Diagnostic Limitations Although antibody tests are useful in suggesting celiac disease autoimmunity, a duodenal biopsy is necessary to confirm the diagnosis. However, due to limited healthcare resources in Nigeria, most children with high antibody levels couldn’t complete a biopsy. Given the expense and accessibility issues related to this procedure, the study relied on combined antibody testing to improve diagnostic accuracy. Despite these constraints, researchers could identify patterns and suggest that screening programs might help to better understand the prevalence of celiac disease among high-risk groups in Nigeria. Comparisons with Other Regions The study’s findings align with similar research in Europe and the Middle East, where celiac disease occurs in approximately 5% of children with Type 1 diabetes. However, in certain African and Middle Eastern countries, the prevalence is often higher, likely due to genetic and dietary factors, as well as varying diagnostic practices. For example, countries like Egypt and Morocco report higher prevalence rates in children with diabetes than observed in Nigeria, which could be due to regional differences in food consumption, healthcare access, or population genetics. Implications for Health Practices in Nigeria This study brings attention to the potential for undiagnosed celiac disease in the general Nigerian population, especially among children with Type 1 diabetes. For individuals with both diabetes and celiac disease, untreated symptoms can lead to poor nutrient absorption, impacting their diabetes management and overall health. Diagnosing and managing celiac disease in young diabetic patients could improve their quality of life and reduce health risks related to nutrient deficiencies. Why These Findings Matter for Children with Type 1 Diabetes For healthcare providers, this research underscores the importance of routine screening for celiac disease in children and adolescents diagnosed with Type 1 diabetes. Early detection can help families and medical teams address dietary adjustments, specifically a gluten-free diet, to prevent complications and manage symptoms effectively. This study encourages proactive healthcare approaches, particularly for those at higher risk, and emphasizes the need for accessible diagnostic tools. By raising awareness and improving screening practices, the healthcare community can work to address the significant but often overlooked burden of celiac disease. Read more at: bmcgastroenterol.biomedcentral.com Watch the video version of this article:

Celiac.com 01/25/2023 - Studies that have tried to measure the effects of a gluten-free diet on the clinical, biochemical and psychological condition of youths with both type 1 diabetes and celiac disease have delivered mixed results. A team of researchers recently set out to evaluate the impact of gluten-free diet on growth, metabolic control and quality of life in children and adolescents with type 1 diabetes and celiac disease. The research team included Enza Mozzillo, Roberto Franceschi, Francesca Di Candia, Francesco Maria Rosanio, Letizia Leonardi, Ludovica Fedi, Valentina Rosà, Vittoria Cauvin, Adriana Franzese, and M. Loredana Marcovecchio. They are variously affiliated with theDepartment of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy; the Department of Pediatrics, S. Chiara Hospital in Trento, Italy; the Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital inTrento, Italy; and the Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. The team first performed a systematic search of studies published in the last 15 years. They used PICOS framework to inform the selection process, and assessed evidence using the GRADE system. Their systematic review included only studies of moderate-high evidence quality level and reporting data on objectively assessed adherence to a gluten-free diet. Their findings highlight pre-adult adherence to a gluten-free diet in youth with type 1 diabetes and celiac disease leads to regular growth, stable BMI, without any negative effect on HbA1c and insulin requirements. Their main finding was that patients who followed a gluten-free diet experienced regular growth without any adverse increase in BMI. Moreover, the gluten-free diet does not negatively affect HbA1c and insulin, but is associated with higher post-meal glucose levels. Evidence from several studies indicate that a gluten-free diet is associated with better lipid profile and major quality of life and the psychological condition of juveniles with both type 1 diabetes and celiac disease. This study offers strong evidence that a gluten-free diet offers major benefits to juveniles with both type 1 diabetes and celiac disease. Read more at Diabetes Research and Clinical Practice.

Celiac.com 01/07/2023 - First reported in 1925, the coexistence of diabetes mellitus and celiac disease is not a new phenomenon. However, as late as 1984, the connection was viewed with skepticism. Prior to the use of intestinal biopsies, some researchers reported an increase of diabetes mellitus among family members of celiac patients, while others reported contradictory findings. After development of techniques for taking jejunal biopsies, modestly increased rates of diabetes were reported. These numbers were usually close to 1% of the celiac patients who were reported as having both diseases. When faced with these increased numbers of diabetes mellitus among celiac families and celiac patients, many asserted that certain genetically determined features of the immune system (HLA) were common among people with either condition. Such genetic factors, they argued, might predispose to autoimmune diseases in general, and would therefore be likely to increase the frequency of both conditions within the same families, and sometimes, within the same individual. The issue was further confounded by the overlap between classical symptoms of celiac disease and diabetes mellitus. Thus, a second diagnosis was often overlooked because all symptoms were considered to result from the first condition diagnosed. The reported rates of coexistence thus underrepresented the true overlap. It was only through systematic research among large numbers of diabetic patients who were biopsied, along with the development and use of serological testing for celiac disease, that the increased coexistence of these diseases gained recognition during the mid to late 1980s. Still, the dominant view ascribed a common origin for both autoimmune conditions. Thus, when other autoimmune diseases were recognized as overly common among celiac patients, little thought was given to the notion that gluten might trigger more than celiac disease. Several startling research findings threatened this perspective and offered a new window through which to view celiac disease and autoimmunity in general. Although this work was initially paid little attention, each of several distinct areas of research were building toward a critical mass. Exploration of intestinal permeability, and its relationship to celiac disease, was investigated throughout the 1990s. This work not only provided convincing evidence for the use of sugar absorption tests to screen for celiac disease in developing nations, it also established that intestinal leakage of food proteins is a consistent feature of active celiac disease. One spin-off result of this work was to increase the credibility of molecular mimicry as a dynamic that followed the leakage of food proteins into the bloodstream. These foreign proteins were shown to cause immune system reactions that damaged both the foreign proteins and self tissues with similar protein structures. Meanwhile, another area of research was increasing the use of serum antibody testing, called celiac panels, which soon revealed that celiac disease was dramatically more common than previously believed. These tests also established that the coexistence of celiac disease and diabetes mellitus was also common. When diabetic patients were tested, about 5% were shown to have celiac disease. When celiac patients were tested, about 10% were found to have diabetes mellitus. Developments in similar serum antibody testing, related other autoimmune diseases, also revealed that compliance with a gluten-free diet, following diagnosis of celiac disease, actually resulted in reductions of these other antibodies. These studies suggested that gluten might actually play a causal role, not only in diabetes, but in a wide range of autoimmune diseases that were previously considered to be coincidentally associated with celiac disease. Hope dawned for many who suffered from a wide range of autoimmune diseases . Simple dietary changes might aid new treatments and bring relief to these many sufferers of autoimmunity. Even in cases where gluten is not the underlying cause, we are gaining understanding of the dynamics by which autoimmunity develops. The crowning moment, with respect to diabetes, came in January of this year when A.J. MacFarlane, et al. published their findings in the Journal of Biological Chemistry. Their work demonstrated that wheat proteins might be a major causal factor in at least some cases of diabetes mellitus. Rooted in prior animal research that was largely spearheaded by Fraser Scott, this most recent research identified immune reactions, in diabetic humans, against wheat proteins which were also closely linked with the attack on the islet cells of the pancreas. This is an exciting moment for those with type 1 diabetes. Many of them may be aided in the maintenance of islet cell transplants (another new development) through following a gluten-free diet. This work also provides a potential turning point for everyone who suffers from autoimmunity. Thanks to the recent establishment of celiac disease as very common in North America, we now know that about 1 in 133 Americans have celiac disease. We also know that this common condition is triggered by gluten. This family of grain proteins also appears to cause some, perhaps many, cases of diabetes mellitus. The evidence against gluten is also growing in the investigation of other autoimmune conditions. It appears that celiac disease will soon be the window through which we will gain a better understanding of autoimmunity, and the gluten-free diet may be the cornerstone of the treatment of many cases of autoimmune diseases.

Celiac.com 04/11/2022 - Researchers and clinicians are just beginning to understand the many connections between celiac disease and diabetes. We've done a number of articles on links between celiac disease and diabetes. We've talked about how a gluten-free diet might help lower diabetes risk. We've looked at the potential role of gluten in Type 1 Diabetes. We've even asked if having type 1 diabetes mellitus and celiac disease automatically mean worse health and quality of life? We know that rates of diabetes are much higher in celiacs than in the general population, and vice versa. We also know that non-diabetic patients often show celiac-specific humoral immunoreactivity at the time of their celiac disease diagnosis. What about diabetic patients? Do they show type 1 diabetes celiac-specific humoral immunoreactivity? To find out, a research team recently looked at celiac-associated humoral autoimmunity in child, adolescent, and adult patients at the onset of type 1 diabetes (DM1) to see if those patients exhibit DM1 celiac-specific humoral immunoreactivity, as do non-diabetic celiac patients at first diagnosis. The research team included Claudio Tiberti Aceliac disease, Francesca Panimolle BS, Margherita Bonamico MD, Blegina Shashaj MD, Tiziana Filardi MD, Federica Lucantoni BS, Raffaella Nenna MD, Francesco Costantino MD, Andrea Lenzi MD, and Susanna Morano MD. They are variously affiliated with the Department of Internal Medicine, University of Rome “Sapienza,” Rome, Italy; the Department of Pediatrics, University of Rome “Sapienza,” Rome, Italy; and the Department of Physiopathology, University of Rome “Sapienza,” Rome, Italy. The team found IgA anti-transglutaminase autoantibodies (IgA-tTGAb) in more than 650 new-onset DM1 serum samples. They then analyzed IgA-tTGAb-positive DM1 samples for IgG-tTG, deamidated gliadin (DGP), and actin antibodies, and compared the results against those from more than 80 screen-detected non-diabetic patients at the time of their celiac diagnosis. In all, nearly thirteen percent of DM1 samples were positive for IgA-tTGAb, with patients 18 years or over showing lower autoantibody frequency, that's about 2.2 times more than in adult patients. Meanwhile, compared with non-diabetic celiacs, IgA-tTGAb+ DM1 patients showed substantially lower IgA-tTGAb titers, IgG-tTGAb, and DGPAb frequency/titers, along with sharply lower average number of celiac-autoantibody positive results per patient. These results show that the age of diabetes onset is negatively associated with risk of celiac disease, that is, the lower age of DM1 onset, the higher the risk of developing celiac disease. Compared with the activity of non-diabetic patients at the time of celiac diagnosis, celiac-specific humoral immunoreactivity is sharply lower at the onset of DM1. The team suggests that a general lower celiac-specific humoral immune response reflects a slower process of celiac disease development in DM1 patients, which is marked by nearly imperceptible gastrointestinal symptoms. This hypothesis is supported by an autoimmune diabetes study that shows a direct correlation between intensity of the humoral immune response and more prominent characteristics of insulin deficiency.* Stay tuned for more stories on connections between celiac disease and diabetes. Read more in Diabetes Care. 2012 Oct; 35(10): 2083–2085 *Buzzetti R, Di Pietro S, Giaccari A, et al. Non Insulin Requiring Autoimmune Diabetes Study Group High titer of autoantibodies to GAD identifies a specific phenotype of adult-onset autoimmune diabetes. Diabetes Care 2007;30:932–938

Celiac.com 09/29/2021 - My endocrinologist suspects I have celiac sprue. I am 47 years old and have had type 1 diabetes since I was 11 years old. HOWEVER...long before the diabetes I experienced severe cramping episodes for which my physicians could never identify a cause. I learned to live with it for 36 years. I am insulin resistant, and “carbohydrate sensitive”, and with the help of a highly competent endocrinologist, have gone from 231 lbs to 177 with an ultimate goal of 135 lbs. I went on an insulin infusion pump in May. The well-meaning diabetes educator was “instrumental” in setting the controls to my pump with the “idea” that I need not go below 120 grams of carbohydrate daily for weight and blood glucose management. As a result I have gained 9 lbs since May, and am working my pump settings back down with the idea of eating 55 - 60 grams of complex carbohydrates daily. My insulin usage is about 67% of what it used to be, yet I can’t take this additional weight off. I was “taught” to eat crackers and juice for low blood glucose level management. All of this paints a picture of my situation today. A few weeks ago I talked to my endocrinologist about my cramping issues. After a boat-load of vials of blood she has arrived at the suspicion that I may have celiac sprue. Since she said that, I have read many articles about this disorder and it seems to fit. It is likely the cause of my lifetime of cramping issues. My mother had “colitis”, and so does my sister. During times of distress they experience intense cramping paired with dizziness, nausea, weakness, and sometimes headaches. Sure sounds like a food issue to me. I try to maintain a 1000 calorie diet. Sometimes (especially if I have had gluten-laden foods, now that I look back and think about it...) I just about starve to death!!!! I am trying to adhere to the South Beach diet. I will be going for a G.I. consult in the near future. As a result of Ron Hoggan’s article in the Spring 2006 edition of this newsletter regarding the low incidence of celiac disease diagnoses with obese people,  I now have hope that I can lose the pain AND the weight with proper diet and exercise. Today I shall try to bear in mind the many great kindnesses that God has done for me, and ignore the relatively insignificant dis-pleasures in my life. A month later: I have stopped eating gluten with a few rare exceptions when my blood glucose levels are low and only glutinous foods are available. The interesting thing is, since I stopped eating the darned stuff, the cramps have ceased!  That seals it for me!! 

Celiac.com 06/09/2020 - What can science tell us about celiac disease screening rates and glycemic outcomes of a gluten-free diet in patients with type 1 diabetes who are asymptomatic for celiac disease? A team of researchers recently set out to assess the issue and get some answers. The research team included Farid H. Mahmud, Antoine B.M. Clarke, Kariym C. Joachim, Esther Assor, Charlotte McDonald, Fred Saibil, Heather A. Lochnan, Zubin Punthakee, Amish Parikh, Andrew Advani, Baiju R. Shah, Bruce A. Perkins, Caroline S. Zuijdwijk, David R. Mack, Dror Koltin, Emilia N. De Melo, Eugene Hsieh, Geetha Mukerji, Jeremy Gilbert, Kevin Bax, Margaret L. Lawson, Maria Cino, Melanie D. Beaton, Navaaz A. Saloojee, Olivia Lou, Patricia H. Gallego, Premysl Bercik, Robyn L. Houlden, Ronnie Aronson, Susan E. Kirsch, William G. Paterson, and Margaret A. Marcon. They are all affiliated with the American Diabetes Association. The team conducted celiac disease screening on asymptomatic patients from 8 to 45 years of age. To assess changes in HbA1c, they randomly assigned biopsy-confirmed celiac disease patients to a gluten-free diet or gluten-containing diet (GCD), along with one year of glucose monitoring. Adults tested positive for celiac disease antibodies more often than children with lower rates of prior celiac disease screening. Twenty-seven subjects went on the gluten-free diet, while twenty-four followed the gluten-containing diet. The team saw no HbA1c differences between the groups, though gluten-free patients showed more substantial glucose increases after meals. Celiac disease is common in asymptomatic patients with type 1 diabetes, and the team advises clinicians to be vigilant about starting those patients on a gluten-free diet. Read more in Diabetes Care 2020 May; dc191944.

Celiac.com 07/04/2019 - There's been some data to suggest that gluten may play a role in diabetes, but there really isn't much data on the role of gluten in type 1 diabetes (T1D), so a team of researchers recently set out to test whether gluten plays a role in type 1 diabetes onset. Specifically, the team wanted to know if a gluten-free diet can decelerate the decline in beta-cell capacity in newly diagnosed non-celiac children with T1D. The research team included Vít Neuman, Stepanka Pruhova, Michal Kulich, Stanislava Kolouskova, Jan Vosahlo, Martina Romanova, Lenka Petruzelkova, Barbora Obermannova, Ondrej Cinek, and Zdeněk Šumník. They are variously affiliated with Charles University in Prague, and the University of Chemistry and Technology in Prague, Czech Republic. For their non-randomized self-selected intervention trial, the team recruited forty-six children, from about 6-13 years old. One group of 26 began a gluten-free diet, while 20 continued on a standard non-gluten-free diet. Main outcomes were the decline in C-peptide area under the curve (AUC) in mixed-meal tolerance tests and the differences in insulin dose, insulin dose adjusted A1c (IDAA1c) and HbA1c at 12 months. Data were analyzed as intention-to-treat by linear regression models adjusted for baseline parameters. The adherence to a gluten-free diet was tested by immunoreactive gluten in stool. Average decrease in C-peptide AUC was 293 vs.484 pmol/L (p=0.3) at 6 months, and 567 vs. 919 pmol/L (p=0.1) at 12 months in the gluten-free diet and control group, respectively. The group that ate a gluten-free diet had a lower insulin dose by 0.22 U/kg/day, lower IDAA1c by 1.5, and lower average HbA1c by 7.5 mmol/mol (p=0.01) after 12 months. Daily carbohydrate intake between the groups was the same. Researchers found immunoreactive gluten in the stool of just 3 patients. Children with type 1 diabetes who ate a gluten-free diet for their first year after diagnosis lower insulin demand and lower HbA1c, although C-peptide dynamics were similar for each group. This is the first study to provide solid data on the connection between gluten intake and type 1 diabetes. The fact that children who follow a gluten-free diet need less insulin is intriguing. Read more at Diabetes 2019 Jun; 68(Supplement 1).

Celiac.com 03/07/2019 - Researchers don’t have much good data on the distribution of the related alleles in the type 1 diabetes Iranian population. In an effort to generate better data, a team of researchers recently set out to assess the frequency of HLA DQ2 and DQ8 haplotypes in patients with type 1 diabetes, with and without celiac disease, and to compare them to the healthy population. The research team included Ali Moheb-Alian, Flora Forouzesh, Amir Sadeghia, Kamran Rostami, Elham Aghamohammadi, Mohammad Rostami-Nejad, Mostafa Rezaei-Tavirani, and Mohammad Reza Zali. The team looked at 70 type 1 diabetes patients who did not have celiac disease, 60 type 1 diabetes cases with celiac disease, and compared them with 150 healthy individuals. They collected ten milliliter Gheparinized blood samples, extracted genomic DNA, and genotyped alleles in Real-time PCR using SYBR Green as a low-resolution method. They found HLA-DQ2 genotypes in 51% of type 1 diabetes patients without celiac disease, and HLA-DQ8 in 23% of such patients. Just over twenty percent of those patients carried both alleles, while 5% carried neither allele. More than 70% of type 1 diabetes patients with celiac disease had DQ2, while nearly 12% carried DQ8. Compared to diabetes patients without celiac disease and the control group, 14% carry both alleles, and 3% carrying neither allele. The frequencies of DQ2 and DQ8 alleles in Iranian healthy population were 19 and 5% respectively. The similarities in genetic background for celiac disease and type 1 diabetes show that HLA-typing can be serve as a helpful tool for spotting celiac disease in people with type one diabetes. Read more in the Journal of Diabetes and its Complicationshttps://doi.org/10.1016/j.jdiacomp.2018.10.001 The researchers are variously affiliated with the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran; the Department of Genetics, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran; the Department of Gastroenterology MidCentral District Health Board, Palmerston North Hospital, New Zealand; the Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and the Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Celiac.com 03/01/2019 - About 30,000 new cases of type 1 diabetes are diagnosed annually in the US, typically in children. If a serious disease affected up to 10% of all type 1 diabetics, wouldn’t you agree that it’s time to sit up and take notice? Perhaps screening for this disease would also make sense. Celiac disease affects 1% of the population, making it a common disease. In the celiac population there is an increased prevalence of type 1 diabetes and this association is well established. Despite celiac disease affecting a much greater percentage of the general population than type 1 diabetes, 90% of the patients suffering from both conditions are first diagnosed with diabetes.[1] Study results vary, but the prevalence of celiac disease among children with diabetes ranges between 4.5% (over 25 studies),[2] to 10%[3] and 12.3%[4] respectively. Opinions on whether screening of all diabetic patients should become part of the medical model are controversial, but fortunately, we are seeing increased support [5,6,9]. It is difficult to overestimate the stress associated with the diagnosis of a severe illness in a child. And perhaps the last thing that a parent wishes to hear is that a second severe illness may be involved. I understand that. But consider the fact that both type 1 diabetes and celiac disease are autoimmune diseases. When a patient has one autoimmune disease they are much more likely to develop another. And obviously the greater the number of such conditions that affect a single individual, the lower their vitality and life expectancy are likely to be. I would recommend to any parent of a child with type 1 diabetes, as well as any adult with the disease, that they get tested for both celiac disease and gluten sensitivity as soon as possible. In my clinical experience we have seen excellent changes when a gluten-free diet was implemented. The facts are these: when celiac disease is diagnosed in diabetics it often occurs within a couple of years of the diabetes diagnosis, but after 5 years the cumulative numbers revealed an estimated 10% incidence of celiac.[3] This is just too common to ignore and the ill effects it creates in these individuals can be dramatic. While it may seem overwhelming to consider, in the long run it could mean the difference between a stable health condition and life-long health challenges. Please let me know if I can be of any assistance. I am here to help. Sources: Ludvigsson JF, “Celiac disease and risk of subsequent Type 1 diabetes” Diabetes Care 29(11), 2483–2488 (2006). Holmes GK. “Screening for coeliac disease in Type 1 diabetes”. Archives of Disease in Childhood. 87(6), 495–498 (2002). Larsson K, et al. “Annual screening detects celiac disease in children with Type 1 diabetes”. Pediatric Diabetes 9(4 Pt 2), 354–359 (2008). Hansen D, et al. “Clinical benefit of a gluten-free diet in Type 1 diabetic children with screening-detected celiac disease” Diabetes Care 29(11), 2452–2456 (2006). Holmes GK. “Coeliac disease and Type 1 diabetes mellitus – the case for screening”. Diabetic Medicine 18(3), 169–177 (2001). Narula P, et al. “Gastrointestinal symptoms in children with Type 1 diabetes screened for celiac disease”. Pediatrics 124(3), E489–E495 (2009). Sanchez-Albisua. “Celiac disease in children with Type 1 diabetes mellitus: the effect of the gluten-free diet. Diabetic Medicine 22(8), 1079–1082 (2005). Goh C. “Prevalence of coeliac disease in children and adolescents with Type 1 diabetes mellitus in a clinic based population”. Postgraduate Medical Journal 83(976), 132–136 (2007). Frohlich-Reiterer EE, et al. “Screening frequency for celiac disease and autoimmune thyroiditis in children and adolescents with Type 1 diabetes mellitus” Pediatric Diabetes 9(6), 546–553 (2008).

Celiac.com 01/30/2019 - Children who receive the rotavirus vaccine may be less likely to develop type 1 diabetes than children who remain unvaccinated, a recent Australian study suggests. Rotavirus can cause severe watery diarrhea, vomiting, fever, and abdominal pain. In some cases, the virus can leave kids with dehydration that is serious enough to require a hospital visit. There is some data to indicate that rotavirus infections can accelerate the development of type 1 diabetes, though researchers don’t yet know why. In May, 2007, health officials introduced a routine oral rotavirus vaccine for infants six weeks and older. In the most recent study, the research team compared rates of type 1 diabetes in the eight years before and the eight years after the vaccine was introduced. The data showed that cases of type 1 diabetes cases declined 14 percent among children age four and younger in the period after the vaccine. The same data showed no significant change in type 1 diabetes cases among older kids. The study wasn’t set up to prove that rotavirus causes type 1 diabetes or how vaccination might help minimize this risk. The findings are only preliminary, lead study author Dr. Kirsten Perrett of the University of Melbourne says that “rotavirus vaccination may be one of possibly many as yet unknown protective environmental and modifiable factors against the development of type 1 diabetes in early childhood.” Perrett stresses that diabetes “has not been clearly linked to other modifiable lifestyle factors and cannot be prevented.” Rotavirus can interfere with insulin production in the pancreas, which could promote type 1 diabetes, Perrett said. The study does add more data to support the idea that viral infections likely contribute to autoimmune disorders like type 1 diabetes and celiac disease in otherwise susceptible people, said Dr. Federico Martinon-Torres a researcher at Hospital Clínico Universitario de Santiago and Instituto de Investigacion Sanitaria de Santiago in Spain. All infants who do not have severely compromised immune systems or a history of bowel obstruction should receive the rotavirus vaccine, says Martinon-Torres. The good news about this study is that a vaccine that is routinely given to most infants seems to offer protection against type 1 diabetes. Source: JAMA Pediatrics, online January 22, 2019.

Celiac.com 12/20/2018 - Patients with monoglandular and/or polyglandular autoimmunity, and their relatives, have higher rates of celiac disease than those without such autoimmunity. Somewhere between 10 and 30% of patients with celiac disease test positive for thyroid and/or type 1 diabetes antibodies, while around 5 to 7% of patients with autoimmune thyroid disease and/or type 1 diabetes test positive for IgA anti-tissue transglutaminase antibodies. A team of researchers recently set out to examine the relationship between celiac disease and endocrine autoimmunity. The research team included George J. Kahalya, Lara Frommera, and Detlef Schuppan. They are variously affiliated with the Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany, the Institute for Translational Immunology and Research Center for Immunotherapy (FZI), Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany, and the Division of Gastroenterology and the Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Celiac disease and endocrine autoimmunity do share a common genetic background, which definitely explains some of the relationship. The main common denominators are HLA antigens DQ2 (DQA1*0501-DQB1*0201) and/or DQ8 (DQA1*0301-DQB1*0302), that are tightly linked to DR3 and DR4, respectively. Researchers have identified functional single nucleotide polymorphisms of various genes involved in immune regulation as susceptibility genes for both celiac disease and monoglandular or polyglandular autoimmunity. This is a promising hypothesis, but exactly how the effects of a gluten-free diet might prevent or ameliorate glandular autoimmunity remains unclear. Based on their results, the research team does recommend that all patients with celiac disease be tested for type 1 diabetes and/or autoimmune thyroid disease. They also recommend that patients with the above autoimmune endocrine disorders be checked for celiac disease. Read more at: Sciencedirect.com https://doi.org/10.1016/j.autrev.2018.05.013

Celiac.com 02/28/2018 - In an effort to discover more genes that trigger type 1 diabetes, a team of researchers recently conducted a large, prospective study of children at risk for type 1 diabetes. The end goal is to reveal more targets for treating or even preventing the disease. The research team included A Sharma, X Liu, D Hadley, W Hagopian, WM Chen, S Onengut-Gumuscu, C Törn, AK Steck, BI Frohnert, M Rewers, AG Ziegler, Å Lernmark, J Toppari, JP Krischer, B Akolkar, SS Rich, JX She; and TEDDY Study Group. The team identified six new chromosomal regions in young people who have already developed type 1 diabetes, or who have started making antibodies against their insulin-producing cells, often a step toward full-blown diabetes that requires lifelong insulin therapy. Their analysis of 5,806 individuals, which is published in the Journal of Autoimmunity, also confirms three regions already associated with one of those related conditions. The team observed two top autoantibodies. The first, called IAA, acts directly against insulin. The second, called GADA, acts against the enzyme glutamate decarboxylase, which regulates the insulin-producing beta cells in the pancreas. According to Dr. She, about 90 percent of patients with type 1 diabetes start with one of the autoantibodies, and many patients eventually end up with both. The second autoantibody may surface in a few days or even years later. They began this study with 176,586 SNPs, or single nucleotide polymorphisms. Nucleotides are basic building blocks of our genetic information. According to Sharma, the SNPs evaluated by TEDDY scientists were already linked with other autoimmune conditions like rheumatoid arthritis or celiac disease, but not type 1 diabetes. The researchers figured out which of these SNPs are different in TEDDY participants with type 1 diabetes versus those with Islet cell autoantibodies versus those with neither. Previous research has shown that the genes associated with IA and actual type 1 diabetes can differ. Dr. She says that even though clinicians regard Islet cell autoantibodies (IA) as a red flag for type 1 diabetes, not every child with IA goes on to develop diabetes, though multiple autoantibodies definitely increase that risk. The team notes that it is possible that the genes that promote IA development may differ from those that lead to full-blown disease progression. She says that this is the first study of gene identification for any disease to use this sort of longitudinal information. She add that this and other studies by the TEDDY research group help to clarify the search for important non-HLA genes by adding the "time to disease" perspective. Source: J Autoimmun. 2018 Jan 5. pii: S0896-8411(17)30739-4. doi: 10.1016/j.jaut.2017.12.008. The researchers are variously affiliated with the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA; Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, US; the Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; the Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom; the Pacific Northwest Research Institute, Seattle, WA, USA; the Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA; the Department of Clinical Sciences, Lund University/CRC, Malmö, Sweden; the Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Aurora, CO, USA; the Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany; Klinikum rechts der Isar, Technische Universität München, Munich-Neuherberg, Germany; Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany; the Department of Pediatrics, Turku University Hospital, Turku, Finland; the National Institutes of Diabetes and Digestive and Kidney Disorders, National Institutes of Health, Bethesda, MD, USA; and the Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.

Celiac.com 10/27/2017 - It has long been understood that two autoimmune diseases, celiac disease and type 1 diabetes are related. They share common genes and the incidence of celiac disease is higher among type 1 diabetics. There have been some anecdotal reports regarding children diagnosed with type 1 diabetes who were put on a gluten-free diet soon after their diagnosis and for a period of two years or more didn't require any insulin. The thought was that the gluten-free diet effectively halted the progression of the diabetes, at least for the duration of the study. Studies of mice have shown that despite utilizing a genetic strain of mice that were strongly in-bred to increase the risk of type 1 diabetes, 2/3 of them did not do so when a drug was administered to prevent leaky gut. This study was performed by Dr. Alessio Fasano at the University of Maryland Celiac Research Center. Dr. Fasano is one of the world's acclaimed researchers in the area of celiac disease and gluten sensitivity. Leaky gut is associated with the initiation and continuation of autoimmune disease and Dr. Fasano's work with these genetically predisposed mice shed a great deal of light on the power of an undamaged gut lining to effectively forestall development of a genetic condition, in this case type 1 diabetes. A recent study out of Immunology, dated August 22, 2012, is titled "Dietary gluten alters the balance of proinflammatory and anti-inflammatory cytokines in T cells of BALB/c mice". The title is a mouthful but here is what the researchers out of Denmark found: Their initial premise was based on the idea, as I mentioned above, that dietary modifications, specifically a gluten-free diet, could reduce the risk of developing type 1 diabetes. The question they posed was, "How did this occur?" They discovered that wheat gluten induced the production of pro-inflammatory chemicals called cytokines that would damage the intestinal lining and immune tissues of the small intestine. More importantly, a gluten-free diet didn't just neutralize the negative effects just mentioned, but it actually caused the production of anti-inflammatory chemicals that would provide protection for the immune system and gut. So, while gluten is a known bad guy, a gluten-free diet doesn't just take the negative away, it actually induces a positive, healing response. Clinically we frequently see this with patients. As soon as we meet a patient with any history of autoimmune disease, we quickly test them for celiac disease and gluten sensitivity via lab tests and a 30 day elimination diet. If we discover any negative immune reaction to gluten, we begin a strict gluten-free diet. Happily, we often see stabilization, if not reversal, of their autoimmune disease. We support the gluten-free diet with our other protocols for normalizing gut permeability (healing a leaky gut) and strengthening the immune system. Taken together this program yields excellent results. If you know anyone suffering from an autoimmune disease, please show them this article. Gluten could be a component in furthering their disease and a gluten-free diet could be a positive influence in their journey to improved health. I hope this was helpful. Please feel free to contact me should you have any questions. And if your health is not at the level you would like, I can also offer you a free health analysis. Call us at 408-761-3900. Our destination clinic treats patients from across the country and internationally and we would be delighted to help you. To your good health.

Celiac.com 07/05/2017 - Numerous researchers have documented a connection between celiac disease and type 1 diabetes. One team of researchers recently set out to examine international differences in celiac disease rates and clinical characteristics of youth with coexisting type 1 diabetes and celiac disease compared with type 1 diabetes only. The research team included Maria E. Craig, Nicole Prinz, Claire T. Boyle, Fiona M. Campbell, Timothy W. Jones, Sabine E. Hofer, Jill H.Simmons, Naomi Holman, Elaine Tham, Elke Fröhlich-Reiterer, Stephanie DuBose, Helen Thornton, Bruce King, David M. Maahs, Reinhard W. Holl and Justin T. Warner. To analyze the relationship between outcomes, including HbA1c, height-standard deviation score [sDS], overweight/obesity, and type 1 diabetes with celiac disease versus type 1 diabetes alone, adjusting for sex, age, and diabetes duration, the team created multivariable linear and logistic regression models. The analysis included 52,721 people under 18 years of age with a clinic visit between April 2013 and March 2014. The team used the following data sources: the Prospective Diabetes Follow-up registry (Germany/Austria); the T1D Exchange Clinic Network (T1DX) (U.S.); the National Paediatric Diabetes Audit (U.K. [England/Wales]); and the Australasian Diabetes Data Network (ADDN) (Australia). The researchers found biopsy-confirmed celiac disease in 1,835 young people, or 3.5%. These patients were diagnosed on average at age 8.1 years, with a range of 5.3 to 11.2 years. Most young people (37%) with diabetes upon celiac disease diagnosis had it for less than one year. Eighteen percent with diabetes had it for 1-2 years at celiac diagnosis, 23% had diabetes between 3 and 5 years at celiac diagnosis, while 17% had diabetes for more than 5 years at celiac diagnosis. Celiac disease rates ranged from 1.9% in the T1DX to 7.7% in the ADDN and were higher in girls than boys (4.3% vs. 2.7%, P < 0.001). Children with coexisting celiac disease were diagnosed with diabetes at 5.4 years on average, compared with those with type 1 diabetes only, who were diagnosed at 7.0 years of age, on average. Also, fewer children with both conditions were non-white, 15 vs. 18%. Height-SDS was lower in those with celiac disease (0.36 vs. 0.48) and fewer were overweight/obese (34 vs. 37%, adjusted P < 0.001), whereas average HbA1c values were comparable: 8.3 ± 1.5% (67 ± 17 mmol/mol) versus 8.4 ± 1.6% (68 ± 17 mmol/mol). This study clearly documented that celiac disease is not uncommon in young people with type 1 diabetes. Differences in disease rates may be due to variations in screening and diagnostic practices, and/or risk levels. Although the groups showed similar glycemic control, the research team encourages close monitoring of growth and nutrition in this population, due to the lower height-SDS. Source: Diabetes Care 2017 May; dc162508. The researchers in this study are variously affiliated with the Children’s Hospital at Westmead, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Charles Perkins Centre Westmead, University of Sydney, Sydney, New South Wales, Australia; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research, Munich-Neuherberg, Germany; Jaeb Center for Health Research, Tampa, FL; Leeds Children’s Hospital, Leeds, U.K.; The University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Australia; Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria; Vanderbilt University Medical Center, Nashville, TN; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.; Women’s and Children’s Hospital, Adelaide, South Australia, Australia; Department of Pediatrics, Medical University of Graz, Graz, Austria; St. Helens and Knowsley Teaching Hospitals NHS Trust, St. Helens, U.K.; John Hunter Children’s Hospital, Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Lucile Salter Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA; and the Children's Hospital for Wales, Cardiff, U.K.