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)
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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.
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...
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.