An Overview of Celiac Disease in Childhood Type 1 Diabetes

Shahramian, Iraj; Bazi, Ali; Sargazi, Alireza

doi:10.5812/ijem.66801

Cited by 11 publications

(8 citation statements)

References 74 publications

(83 reference statements)

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“…The proportion of MetS in LADA is comparable to its prevalence in T2DM patients [ 25 ]. When we consider isolated components of MetS, LADA patients had a non-statistically significant trend to have more often BMI over 25 kg/m 2 , hypertension and dyslipidaemia, which confirms other published results [ 21 ]. These differences reflect the important role of adiposity and insulin resistance in the pathogenesis of LADA and its related complications [ 1 , 3 , 6 ].…”

Section: Discussionsupporting

confidence: 89%

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Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Fadiga

Saraiva

Catarino

et al. 2020

Diabetol Metab Syndr

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Introduction Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA. Methods We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR–15) for T1DM and 42 years (IQR–15) for LADA (p = 0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p < 0.001). The mean BMI at diagnosis was 24.1 kg/m2 in T1DM group and 26.1 kg/m2 in LADA group (p = 0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p = 0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p < 0.001). The median daily insulin dose was 40 IU for T1DM (0.58 IU/kg) and 33.5 IU for LADA (0.57 IU/kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p = 0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p = 0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p = 0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.

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Section: Discussionsupporting

confidence: 89%

“…The most frequent comorbidity was thyroid autoimmune disorder. Interestingly, no patient had the diagnosis of celiac disease, which is frequently associated to childhood T1DM [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Fadiga

Saraiva

Catarino

et al. 2020

Diabetol Metab Syndr

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“…When we consider isolated components of MetS, LADA patients had a non-statistically signi cant trend to have more often BMI over 25Kg/m 2 , hypertension and dyslipidaemia, which con rms other published results [21]. These differences re ect the important role of adiposity and insulin resistance in the pathogenesis of LADA and its related complications [1,3,6].…”

Section: Metabolic Control and Diabetes Complicationssupporting

confidence: 81%

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Fadiga

Saraiva

Catarino

et al. 2020

Preprint

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Introduction: Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA.Methods: We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results: We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR – 15) for T1DM and 42 years (IQR – 15) for LADA (p=0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p<0.001). The mean BMI at diagnosis was 24.1Kg/m2 in T1DM group and 26.1Kg/m2 in LADA group (p=0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p=0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p<0.001). The median daily insulin dose was 40IU for T1DM (0.58IU/Kg) and 33.5IU for LADA (0.57IU/Kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p=0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p=0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p=0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion: Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.

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“…7 Patients with T1D and CD may be asymptomatic or present with mild symptoms. 8,9 In patients with T1D, the coexistence of CD not only affects intestinal absorption of nutrients and calcium and skeletal metabolism but also may contribute to the higher risk of cardiovascular incidents and exaggerate complications such as nephropathy, retinopathy, and neuropathy. 10,11 Having a CD diagnosis for ≥15 years was associated with a 2.8-fold increased risk of death in individuals with T1D (95% CI, 1.28-6.12).…”

Section: Introductionmentioning

confidence: 99%

Celiac disease in children with type 1 diabetes varies around the world: An international, cross‐sectional study of 57 375 patients from the SWEET registry

Taczanowska

Schwandt

Amed

et al. 2020

Journal of Diabetes

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Background: Children with type 1 diabetes (T1D) are at much higher risk of developing celiac disease (CD) than the general population. The aim of the study was to assess the prevalence and differences in clinical presentation of CD in T1D in different regions of the world. Methods: This study is based on the Better control in Pediatric and Adolescent diabeteS: Working to crEate cEnTers of Reference (SWEET) database. There were 57 375 patients included in the study, aged ≤18 years from 54 SWEET centers. Only centers with screening for celiac disease were included. Regression models adjusted for age, diabetes duration, and gender and a fixed effect in the models for region was used. Diabetes duration, age at diabetes onset, and sex were presented as unadjusted results. Results: CD was present in 2652 subjects (4.5%), with different prevalence among regions: from 1.9% in Asia/Middle East to 6.9% in Australia/New Zealand. CD was observed more often among females. Comparing children with and without CD, characteristics for those with CD were younger age at diabetes onset (6.3 [3.3; 9.8] vs 8.1 [4.6; 11.3], P < 0.001) and had longer diabetes duration (6.4 [3.6; 9.8] vs 4.8 [2.1; 8.2], P < 0.001). Further, they had lower glycosylated hemoglobin (HbA1c) in Europe and North America/Canada; lower body mass index (BMI)-SD score (BMI-SDS) in southern Europe, North America, and Canada; In most regions daily insulin dose was lower, height-SDS was lower, and the percentage of insulin pump users was higher in children with T1D and CD. Conclusions:The prevalence and the anthropometric and metabolic consequences of CD in children with T1D differ around the world.

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An Overview of Celiac Disease in Childhood Type 1 Diabetes

Cited by 11 publications

References 74 publications

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Celiac disease in children with type 1 diabetes varies around the world: An international, cross‐sectional study of 57 375 patients from the SWEET registry

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