Celiac disease in adult patients with type 1 diabetes mellitus

Czech version

Authors: Iva Haladová; Daniela Čechurová; Silvie Lacigová; J. Gruberová; Zdeněk Rušavý; Karel Balihar
Authors‘ workplace: Diabetologické centrum I. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Martin Matějovič, Ph. D.
Published in: Vnitř Lék 2014; 60(7-8): 562-566
Category: Original Contributions

Overview

Objective:
To assess the prevalence of celiac disease in adult patients with type 1 diabetes mellitus (T1DM). Influence the new started treatment of celiac disease on glycemic control and body mass index (BMI) of the patients. Prevail the anti-transglutaminase antibody (atTG) positivity one year after commencement of the therapy.

Methods:
A retrospective assessment of celiac disease targeted screening in 465 adult T1DM patients at Diabetes Center, 1st Medical Department, University Hospital in Pilsen (80 % of all T1DM patients) from 1. 1. 2007 until 1. 7. 2011. Enterobiopsy was indicated in case of atTG-A (or atTG-G) positivity. In patients with newly started gluten-free diet, HbA_1c and BMI within a year after diagnosis of celiac disease were compared to a year period six months after treatment commencement (3–4 visits), atTG was evaluated one year after treatment beginning. Paired T-test was used for statistical evaluation.

Results:
The prevalence of all forms of celiac disease in the studied group was 10.5 %. Celiac disease diagnosed in childhood was found in 1.1 % patients (5/465). Positivity of atTG was newly observed in 9.5 % (44/465) patients. Three patients with atTG > 300 kIU/l refused the enterobiopsy examination. Celiac disease is highly plausible. The influence of gluten-free diet on BMI and HbA_1c could not be evaluated due to the lack of compliance. 22 patients had a potential form of celiac disease (negative histology). Positive enterobiopsy was found in 19 patients (4.1 %). Another 3 patients had to be excluded from the subgroup of 22 patients (newly indicated gluten-free diet) as the HbA_1c values and BMI were affected by the primary diagnosis of T1DM.

Subgroup characteristics:
9 women and 7 men, mean age 38 ± 12 years, diabetes duration 21 ± 13 years, celiac disease diagnosed 20.7 ± 13 years since first diagnosis of T1DM. No statistically significant change in HbA_1c (67 ± 11.4 vs 69 ± 13.9 mmol/mol) was observed in the studied period, however and a significant change of BMI from 25.4 ± 4.2 to 25.9 ± 4.3 (p < 0.01) was found. The atTG positivity prevailed in 47 % (9/19) of patients after one year.

Conclusion:
A total prevalence of the celiac disease in the group of adult T1DM patients was 10.5 %. No significant change in HbA_1c occurred following treatment, a significant change of BMI was observed. The atTG positivity prevailed in 47 % of patients after one year.

Key words:
celiac disease – gluten free diet – prevalence – type 1 diabetes

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