Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study

Paruk, Imran; Naidoo, V.G.; Pirie, Fraser; Maharaj, Sureka; Nkwanyana, None Ntombifikile M.; Dinnematin, Hilary L; Ganie, Yasmeen; Ramdial, Pratistadevi K.; Motala, Ayesha A.

doi:10.1111/jgh.14596

Cited by 14 publications

(8 citation statements)

References 39 publications

(86 reference statements)

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“…Alternatively, a lack of awareness and the false belief that CD does not occur in black ethnic groups may lead to a lowered detection rate and therefore a low prevalence of diagnosed CD in sub-Saharan Africa. This is supported by Paruk et al, [14] who reported a similar prevalence of CD in SA black patients with type 1 diabetes as studies from Western countries. Poor access to serological screening tests and confirmatory endoscopy may have an additional effect, as not all healthcare centres are well resourced or adequately equipped in our setting.…”

Section: Researchsupporting

confidence: 76%

The prevalence of coeliac disease-associated human leukocyte antigens in South African transplant donors and recipients

et al. 2021

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Coeliac disease (CD) was previously thought to be a disease of people of European descent, but this perception has changed in the past few decades. [1] More recently, CD has been described to be prevalent in the Middle East, South America and North Africa. [1] There is a notable lack of studies on CD in sub-Saharan Africa, and the perception that CD does not exist in black southern African patients persists. The disease is therefore often not often considered in patients with compatible clinical presentations such as chronic diarrhoea and malnutrition, two common conditions in South Africa (SA). [2] Furthermore, atypical presentations of CD (e.g. iron deficiency, altered bone metabolism, elevated serum liver enzymes, short stature) have been shown to be common, leaving much of the CD 'iceberg' unrecognised. [3] The genetic system bearing the strongest disease association with CD is the human leukocyte antigen (HLA) major histocompatibility class II genes HLA-DQ2.5 and HLA-DQ8. [4] Approximately 90 -95% of CD patients carry HLA haplotype HLA-DQ2.5 heterodimers (encoded by DQA1*05 and DQB1*02 alleles) or HLA-DQ8 (DQB1*03:02) in combination with a DQA1*03 variant. [5] The remaining 5% of CD patients without HLA-DQ2.5 or HLA-DQ8 are thought to have an HLA-DQ2.2 haplotype (DQA1*02:01-DQB1*02:02). [6] Although several genomic areas outside the HLA region associated with CD have been identified, their contribution to predisposition to CD is relatively small. [5] ObjectivesIn southern Africa, the general population's predisposition to CD has not been reported. The objective of this retrospective study was to report on the prevalence of HLA-DQ2.5 and HLA-DQ8 in the SA population using HLA data collected by the Tissue Immunology Laboratory at the South African National Blood Service (SANBS) for the purposes of transplantation. MethodsEthical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee (ref. no. M190670) and the SANBS Human Research Ethics Committee (ref.no. 2019/0481). All patients typed as part of the tissue immunology work-up or for inclusion on the bone marrow registry (through the Sunflower Fund) were included. HLA typing was performed by lowto medium-resolution Luminex typing utilising a Labtype rSSO kit (One Lambda, Thermo Fisher Scientific, USA) and acquired on LabScan 200 and Flex Map 3D (Thermo Fisher Scientific, USA). Briefly, this process utilises bead-complexed sequence-specific oligonucleotides to define genetic HLA typing. HLA class II data were expressed in a two-digit format. Data were recorded on the SANBS electronic database and extracted in a de-identified format. Where known, patient ethnicity, gender and age and reason for typing were also included. Ethnicity was self-reported and classified This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Researchsupporting

confidence: 76%

The prevalence of coeliac disease-associated human leukocyte antigens in South African transplant donors and recipients

et al. 2021

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“…This is much lower than the reported prevalence of 44.5% and 32.2% in paediatric and adult patients, respectively in Durban, South Africa. [17,18] This may occur as a result of different antibody testing. Serology was positive based on either tTG-A or EMA, while in the adult study patients' serology was deemed positive if any of the three antibodies were positive (tTG-A, EMA, anti-gliadin antibodies [AGA]).…”

Section: Discussionmentioning

confidence: 99%

“…Serology was positive based on either tTG-A or EMA, while in the adult study patients' serology was deemed positive if any of the three antibodies were positive (tTG-A, EMA, anti-gliadin antibodies [AGA]). [17,18] EMA and tTG-A both have a specificity and sensitivity >90% in symptomatic individuals (Table 3). [3][4][5]21] When used as screening tests, however, their positive predictive value is lower, in the range of 70 -83%.…”

Section: Discussionmentioning

confidence: 99%

“…[17] A later study of adult type 1 diabetic patients in the same region, which included patients who were diagnosed in childhood (with earliest onset of diagnosis of 10.3 years) showed a prevalence of 32.2% for serology-positive CD, while the prevalence of biopsy-confirmed CD was 2.5% (similar to Western countries). [18] The diagnosis of CD is based on a combination of serology testing, small-intestinal biopsy and response to a gluten-free diet. [3] Confirmation of the diagnosis of CD can be made by demonstrating subtotal villus atrophy (as outlined in the Marsh Classification) on small-bowel biopsy.…”

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confidence: 99%

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Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a tertiary hospital in South Africa

Karsas

Terblanche

Kemp

et al. 2021

SAJCH

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Background. International literature has shown the prevalence of coeliac disease (CD) in children and adolescents with diabetes to range from 1 - 10%. Prevalence rates in African countries are limited or unknown. Objective. The objective was to describe the prevalence of CD in all children and adolescents with type 1 diabetes mellitus presenting to the paediatric and adult diabetic clinic at Steve Biko Academic Hospital, Pretoria, South Africa. Method. A retrospective review of the files of all children and adolescents in the paediatric and adult diabetic clinic with type 1 diabetes mellitus between August 2016 and June 2019 was conducted. Children requiring screening and/or intestinal biopsies were also prospectively included during this period. The setting of this study was Steve Biko Academic Hospital, a tertiary referral centre, in Pretoria, South Africa. Coeliac screening included anti-deaminated gliadin antibodies and anti-tissue transglutaminase antibodies (both IgA and IgG). All biopsies were obtained by a paediatric gastroenterologist or an experienced paediatric surgeon. Results. A total of 184 files were screened; 132 met inclusion criteria but only 108 patients in total had coeliac screening. Positive antibody screening for CD was found in 11 out of 108 patients (10.2%). Nine of the 11 serology-positive patients had biopsies performed. Out of the nine biopsies, two (22.2%) were positive for CD based on the Marsh-Oberhuber classification. Conclusion. This study found a prevalence of serology-positive CD in our local population of South African children with type 1 diabetes mellitus of 10.2%, while the prevalence of biopsy-confirmed CD was found to be 1.9%.

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“…Systemic inflammation is associated with the whole course of T2DM, and it plays an important role in the development and progression of DR. Activation of B cells contributed to the development of DM in recent years [ 21 – 23 ]. However, the immune response mediated by B cells has been rarely reported in the DR patients [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Qualitative and Quantitative Analysis of B-Cell-Produced Antibodies in Vitreous Humor of Type 2 Diabetic Patients with Diabetic Retinopathy

Liu

et al. 2020

Journal of Diabetes Research

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Aim. To analyze the levels of B-cell-produced antibodies in the vitreous humor of patients with or without diabetic retinopathy (DR) both qualitatively and quantitatively. Methods. A total of 52 type 2 diabetes mellitus (T2DM) with DR patients and 52 control subjects without diabetes mellitus or inflammatory diseases were included in this prospective study. The levels of immunoglobulin (Ig)A, IgM, and IgG subtypes were measured using a magnetic color-bead-based multiplex assay. Results. The concentrations of IgA, IgM, and total antibodies in the DR group were significantly higher than those in the control group (all p<0.001), but there was no significant difference in the 4 IgG subtypes between the two groups after Bonferroni correction. Pearson’s correlation analysis revealed low negative correlations between levels of antibodies (IgA, IgM) and estimated glomerular filtration rate (eGFR, r=−0.443, r=−0.377, respectively, both p<0.05). Furthermore, multiple linear regression analysis yielded three equations to predict the concentrations of IgA, IgM, and total antibodies in the vitreous humor according to eGFR and other clinical variables (r=0.542, r=0.461, and r=0.312, respectively, all p<0.05). Conclusion. Increased levels of IgA, IgM, and total antibodies produced by B cells were observed in the vitreous humor of T2DM patients with DR. There were low negative correlations between levels of antibodies (IgA, IgM) and eGFR.

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Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study

Cited by 14 publications

References 39 publications

The prevalence of coeliac disease-associated human leukocyte antigens in South African transplant donors and recipients

The prevalence of coeliac disease-associated human leukocyte antigens in South African transplant donors and recipients

Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a tertiary hospital in South Africa

Qualitative and Quantitative Analysis of B-Cell-Produced Antibodies in Vitreous Humor of Type 2 Diabetic Patients with Diabetic Retinopathy

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