Clinical Spectrum of Comorbid Coeliac Disease in Type 1 Diabetes Mellitus- a Tertiary Care Centre Based Study in Assam Medical College and Hospital (original) (raw)
European Journal of Internal Medicine, 2013
Background: Patients with type 1 diabetes mellitus (T1DM) are more prone to develop other auto-immune diseases, including coeliac disease (CD). Paediatric patients with T1DM are screened for CD, whereas in adult T1DM patients screening programs for CD are not standardised. The aim of this study was to investigate clinical and genetic characteristics of patients with both diagnoses so as to lead to better detection of CD in adult patients with T1DM. Methods: We studied 118 patients with both T1DM and CD identified in The Netherlands. We retrospectively collected data on sex distribution, age of onset of T1DM, age of CD diagnosis, CD complaints, duration of CD complaints before CD diagnosis, family history of CD or T1DM, comorbidity and HLA-DQ type. Results: Thirty-three percent of T1DM + CD patients reported CD related complaints for at least 5 years before CD diagnosis. Two peaks in the age of CD diagnosis in T1DM patients were observed: around 10 and 45 years of age. Women were diagnosed with CD at a younger age than men (median 25 years (IQR 9-38) versus 39 (12-55) years, respectively, P b 0.05). Conclusion: A delay of CD diagnosis is frequently found in adult T1DM patients and two peaks in the age of CD diagnosis are present in T1DM patients. This observational study emphasises that more frequent screening for CD in particularly adult T1DM patients is required, preferably by a 5 years interval.
High prevalence of coeliac disease in Danish children with type I diabetes mellitus
Acta Paediatrica, 2007
The purpose of this population-based study was to determine the prevalence of coeliac disease (CD) in 106 Danish children (age 2-18 y) with type I diabetes mellitus compared with 106 ageand sex-matched healthy controls. Serum samples were analysed for immunoglobulin A (IgA) and IgG gliadin antibodies by enzyme-linked immunosorbent assay (ELISA), for IgA endomysium antibodies (EMA) by immuno uorescence and for IgA tissue transglutaminase antibodies (tTGA) by ELISA. None of the controls had EMA or tTGA. Two diabetics previously diagnosed with CD were antibody negative on a gluten-free diet. Ten diabetics had both EMA and tTGA. Intestinal biopsy was performed in nine of them. All biopsies showed a histological picture of partial or total villous atrophy con rming the diagnosis of CD. Diabetics with CD were signi cantly younger (p = 0.026), had an earlier onset of diabetes (p = 0.005), had a lower height standard deviation score (p = 0.019) and more often had thyroid antibodies (p = 0.040) compared with diabetics without CD. Conclusion: A high prevalence of CD of 10.4% (95% con dence interval 4.6-16.2%) was found in young Danish diabetics. Early onset of diabetes may predispose to CD. Routine serological screening for CD may be valuable in patients with type I diabetes mellitus.
Coeliac Disease: Frequent Occurrence After Clinical Onset of Insulin-dependent Diabetes Mellitus
Diabetic Medicine, 1996
Coeliac disease was searched for in a series of 776 children with newly diagnosed IDDM. During the follow-up of 2 to 3 years from diagnosis, reticulin and gliadin antibodies w e r e measured, and a jejunal biopsy was performed in those cases with high levels of antibodies; 19 children were identified with coeliac disease, giving the prevalence of 2.4 %. In only one case had coeliac disease been diagnosed before IDDM. Nine patients with proven coeliac disease were negative for antibodies when lDDM was diagnosed, but became positive within 24 months. All patients found to have coeliac disease were positive for IgA reticulin antibodies, but only 12 of 18 (67 Yo) showed a high level of IgA gliadin antibodies. Of the 18 patients genotyped for HLA DR locus, 14 (78 YO) were positive f o r DR3 and 10 (56 %) were positive for DR4. DQBl*0201 allele was present in 17 of 18 patients (94 YO). Coeliac disease in children with IDDM tends to develop soon after diabetes is diagnosed. Routine screening for coeliac disease is recommended repeatedly during the first years after the diagnosis of IDDM.
This study aimed to assess the impact of screening positive for coeliac disease on a population of adults with type 1 diabetes. Fifty-three patients were identified with a positive screen for coeliac disease, out of a population of 2,752 individuals with type 1 diabetes (minimum prevalence 1.9%). Prior to screening, 32% of patients were asymptomatic. Only a fifth of patients found no improvement in well-being with a gluten-free diet and in those who followed a strict gluten-free diet the improvement in well-being was greater (p=0.034). Screening was felt to be beneficial by 73%. The response did not relate to gluten-free diet adherence but did relate to symptom improvement (p=0.037). These data show that patients report an improvement in well-being with treatment and feel that screening for coeliac disease is beneficial.
Screening for coeliac disease in an adult cohort of patients with type 1 diabetes
The British Journal of Diabetes & Vascular Disease, 2009
Patients with type 1 diabetes have an increased prevalence of coeliac disease as compared with the general population due to common genotypes. Recent evidence has suggested that deregulation of gastrointestinal mucosal immunity may be essential to the development of both diseases. Currently, strong evidence supports the serological screening of paediatric patients with type 1 diabetes for coeliac disease. A key clinical question in the management of type 1 diabetes is whether adult patients should be routinely screened for coeliac disease. To investigate the use of coeliac screening in endocrine practice we retrospectively reviewed the records of 4,138 patients attending our diabetes centre over a four-year period and identified 572 patients with type 1 diabetes. We found that approximately one out of five patients with type 1 diabetes had been serologically screened for coeliac disease. The prevalence of coeliac disease at 1.69% in this adult cohort was lower than expected. This de...
2020
Coeliac disease (CD) is more common in children and adolescents with type 1 diabetes (T1D). Both diseases share the same high-risk genes: human leukocyte antigen (HLA) DQ2 and DQ8. Other factors than gluten intake and high-risk genes are necessary to develop CD. In Sweden, there was a dramatic increase in CD in young, otherwise healthy, children between 1984 and 1996 and this has been called the "Swedish epidemic of coeliac disease", hereinafter referred as the Swedish CD epidemic. Over the last decade, the diagnostic guidelines for CD in children and adolescents have changed, but children with T1D are still not included in protocols to determine CD diagnosis without a biopsy, due to a lack of data. The overall purpose of this dissertation was to expand current knowledge about CD in children and adolescents with T1D, with regard to the screening, diagnosis and prevalence of CD. One aim was to investigate the prevalence of CD in Swedish children and adolescents with T1D and compare the prevalence in individuals born before, during and after the Swedish CD epidemic. Another aim was to explore how CD screening in children and adolescents with T1D may be improved. In Study I, we examined the medical records of 1,151 paediatric patients at a diabetes clinic in Stockholm to determine the prevalence of CD in children and adolescents with T1D, as well as the prevalence of CD in three subgroups. These were children born before, during and after the Swedish CD epidemic. In Study II, we investigated the prevalence of CD in patients with T1D at a Swedish national level, using several databases. We identified 1,642 children with T1D born during the Swedish CD epidemic (1992)(1993) and 1,380 born after the epidemic (1997)(1998). The total number of individuals born during these years was 430,374. In Studies III and IV, we used national cohort data from the Swedish prospective study Better Diabetes Diagnosis (BDD). In Study III, we analysed blood samples from 2,705 children and adolescents when they were diagnosed with T1D, to determine the links between HLA-DQ2 and HLA-DQ8, CD biomarker tissue transglutaminase (tTG) and diabetes autoantibodies. In Study IV, we analysed information from 2,035 children and adolescents with T1D, combined with data from the medical records kept by their diabetes clinics, to evaluate if high levels of tTG could predict CD. All the studies were approved by the Swedish Ethical Review Authority. Every tenth child and adolescent with T1D in Sweden also had CD. No difference in CD prevalence was found in children with T1D born before, during or after the Swedish CD epidemic. Many children were diagnosed with both diseases almost at the same time and the majority were diagnosed with CD within two years of being diagnosed with T1D. The CD biomarker tTG was related to the HLA high-risk genes DQ2 and DQ8, but not to diabetes autoantibodies. These risk-genes were absent in approximately 8% of the children with T1D. When the CD biomarker tTG was 10 times above the upper limit of normal, it was accurate in predicting CD in children and adolescents with T1D. The prevalence of CD in children and adolescents with T1D in Sweden was shown to be one of the highest in the world. Children with T1D were not affected by different gluten intake recommendations in infancy, unlike the general population during the Swedish CD epidemic. This finding can be taken into account when planning both long-term observational studies and interventional studies about how to prevent CD. HLA was only useful in identifying the T1D population that was not at-risk of developing CD. We recommend repeated CD screening in children with T1D and HLA DQ2 and/or DQ8, and suggest that the first two years after their T1D diagnosis is the most important time. It is also suggested that guidelines for diagnosing CD in screened children should also apply to children with T1D, with regard to when biopsies can be avoided.