Screening Detected Celiac Disease in Children with Type 1 Diabetes Mellitus: Effect on the Clinical Course (A Case Control Study)

Abstract

In a cohort of diabetic children, silent celiac disease had no obvious effect on metabolic control but negatively influenced weight gain.

Type 1 Diabetes Mellitus and Co-Morbidities

“…Thyroid dysfunction could be responsible of variations in absorption of carbohydrates and increased insulin resistance. There are studies showing similar diabetes control in patients with and without a second autoimmunity, in these studies thyroid autoimmunity does not lead to worsening of diabetic metabolic control in children with T1D (Kordonouri et al, 2002;Rami et al, 2005;Sumnik et al, 2006). The thyroid status is not different between diabetic patients with and without CD: children with both T1D and CD do not have an increased risk of AIT development compared to diabetic patients without CD (Sumnik et al, 2006).…”

“…Similarly, children with T1D with evidence of symptomatic CD benefit from GFD (Hansen et al, 2006;Saadah et al, 2004); in symptom-free cases the demonstrated benefit is limited to weight gain and bone mineral density (BMD) changes. ( Artz et al, 2008;Rami et al, 2005;Simmons et al, 2007). Recently a 2-year prospective follow up study has provided additional evidence that only in some of the children with T1D and few classical symptoms of CD, identified by screening as being TG+ present, the demonstrated benefit of GFD is limited to weight gain and BMD changes (Simmons et al, 2011); moreover, other authors have reported an improved glycemic control in GFD-compliant celiac patients (SanchezAlbisua et al, 2005).…”

“…Recently a 2-year prospective follow up study has provided additional evidence that only in some of the children with T1D and few classical symptoms of CD, identified by screening as being TG+ present, the demonstrated benefit of GFD is limited to weight gain and BMD changes (Simmons et al, 2011); moreover, other authors have reported an improved glycemic control in GFD-compliant celiac patients (SanchezAlbisua et al, 2005). On the contrary, silent untreated CD has no obvious effect on metabolic control in T1D patients, but could negatively influence weight gain (Rami et al, 2005). In any case, the adherence to GFD by children with T1D has been reported generally below 50% (Acerini et al, 1998;Crone et al, 2003;Hansen et al, 2006;Saadah et al, 2004, Westman et al, 1999.…”

Celiac disease and diabetes mellitus type 1.

“…Classical presentation of CD can occur in T1DM patients, but many patients with CD and T1DM are either asymptomatic (silent CD) or present with only mild symptoms 72,73 . In a recent study from a North American CD clinic, 71.4% of children with diabetes reported no gastrointestinal symptoms at the time of a positive screen 74 .…”

Gluten-free diet does not influence the occurrence and the Th1/Th17-Th2 nature of immune-mediated diseases in patients with coeliac disease

“…CD is frequently associated to other Th1/Th17-IMD M a n u s c r i p t To date, a gluten free diet (GFD) is considered the only treatment for CD. Numerous papers have investigated the effects of CD therapy on the incidence and prognosis of coexisting or subsequent IMD but thus far they have reported contradictory results [26][27][28][29][30][31][32][33][34][35]. The aims of our study were: 1) to establish the prevalence of IMD at the time and after CD diagnosis in a large sample of adult individuals; 2) to identify any possible changes in immune response after commencement of GFD, in particular with regard to shifts from Th1/Th17-to Th2-immune response or vice versa; and 3) to investigate the potential role of GFD in reducing and/or preventing IMD in adult CD patients.…”