Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes

Elfström, Peter; Sundström, Johan; Ludvigsson, Jonas F.

doi:10.1111/apt.12973

Cited by 166 publications

(141 citation statements)

References 68 publications

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“…At present, Swedish patients with T1D are screened for CD, but because such screening did not occur in the early part of our study period, we cannot rule out the possibility that some individuals classified as having T1D alone may also have undiagnosed CD. However, because individuals with T1D and undiagnosed CD would not make up .3-4% of our reference group (if the average CD prevalence in T1D is 6% [7]), such misclassification would not affect our risk estimates more than marginally. In summary, this is the largest study to date demonstrating that concomitant CD and T1D influences the likelihood of developing ATD.…”

Section: Discussionmentioning

confidence: 99%

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Celiac Disease Increases Risk of Thyroid Disease in Patients With Type 1 Diabetes: A Nationwide Cohort Study

et al. 2015

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OBJECTIVEBoth type 1 diabetes (T1D) and celiac disease (CD) have been linked to autoimmune thyroid disease (ATD). We examined if individuals with both T1D and CD were at a higher risk of ATD than those with only T1D. RESEARCH DESIGN AND METHODSThis study was a nationwide population-based cohort study. We defined T1D as having an inpatient or a hospital-based outpatient diagnosis of T1D at age £30 years in the Swedish National Patient Register between 1964 and 2009. Data on CD were obtained through small intestinal biopsy reports showing villous atrophy (Marsh histopathology grade III) between 1969 and 2008 at any of the 28 pathology departments in Sweden. ATD included hyperthyreosis and hypothyreosis, defined according to the Swedish National Patient Register. We identified 947 individuals with T1D and biopsy-verified CD. These were matched to 4,584 control subjects with T1D but no CD diagnosis. Cox regression then estimated the risk of ATD. RESULTSAmong T1D, CD was a risk factor for later ATD. During follow-up, 90 T1D+CD patients developed ATD (expected n = 54). Adjusting for sex, age, and calendar period, this corresponded to a hazard ratio (HR) of 1.67 (95% CI 1.32-2.11; P < 0.001). This excess risk was highest in those who had CD for 10 years or more (HR 2.22 [95% CI 1.49-3.23]). Risk increases were seen in both males and females. CD was a risk factor for both hypothyreosis (HR 1.66 [95% CI 1.30-2.12]) and hyperthyreosis ). CONCLUSIONSAmong patients with T1D, CD is a risk factor for the later development of ATD.Celiac disease (CD) is an immune-mediated enteropathy that has a prevalence of 1% in Western populations (1). It occurs in genetically susceptible individuals after exposure to dietary gluten, which is a protein found in wheat, barley, and rye. Strict adherence to a gluten-free diet is the mainstay of treatment for CD, which reduces the risk of developing serious complications such as lymphoma, osteoporosis, hyposplenism, anemia, and other micronutrient deficiencies (2). CD has been linked to both type 1 diabetes (T1D) and autoimmune thyroid disease (ATD) (3,4). The development of autoimmune conditions in CD may be related to the duration of gluten exposure, although previous findings from the literature are conflicting (5,6).

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Section: Discussionmentioning

confidence: 99%

“…Further supportive of a link between these three immune-mediated conditions is the higher prevalence of CD in both T1D and ATD (7)(8)(9)(10).…”

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confidence: 95%

Celiac Disease Increases Risk of Thyroid Disease in Patients With Type 1 Diabetes: A Nationwide Cohort Study

et al. 2015

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“…The prevalence of celiac disease (CD) in patients with type 1 diabetes mellitus (T1DM) is between 3 and 10%, being more than 10 times the prevalence in the general population (1). Both diseases result from a complex interplay between genetic susceptibility and environmental exposure, being associated with the major histocompatibility complex class II antigen DQ2, and share non-HLA loci (2).…”

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confidence: 99%

High Rate of Spontaneous Normalization of Celiac Serology in a Cohort of 446 Children With Type 1 Diabetes: A Prospective Study

et al. 2015

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OBJECTIVEIn children with type 1 diabetes mellitus (T1DM), elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize, despite continued consumption of gluten. We aimed to investigate the prevalence of spontaneous normalization of anti-tTG levels and the existence of factors predictive for this outcome. RESEARCH DESIGN AND METHODSAll children referred from 2002 to 2012 were screened for celiac disease (CD) at diabetes onset and at specific intervals. In the presence of a high anti-tTG titer or clinical symptoms, children were offered endoscopy, and asymptomatic patients with a low anti-tTG titer were invited to a second serological test after 6 months of eating a gluten-containing diet. RESULTSThe study included 446 children. Of these, 65 (14.5%) became positive for celiac serology: 38 (58%) had a persistently elevated anti-tTG titer and 27 (41%) fluctuating anti-tTG titer; 18 (28%) became negative. The prevalence of positive CD autoimmunity and overt CD was 14.3% (95% CI 11-17) and 8.5% (95% CI 5-10), 15-and 8-times higher than the general pediatric population, respectively. Asymptomatic children older than 9.1 years at T1DM onset had the lowest risk to develop CD. CONCLUSIONSSerum anti-tTG levels decreased spontaneously in 40% of children with T1DM and became negative in 20%, despite gluten consumption. This finding supports the hypothesis of a state of temporary positivity of celiac serology in children with diabetes. In absence of clinical symptoms or signs of CD, histological confirmation of the disease and the gluten-free diet should be postponed to avoid unnecessary procedures and reduce an additional psychological burden.

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“…The prevalence was highest among children (6.2%) and lowest among adults (2.7%). 16 The heterogeneity of the prevalence of the association between CD and T1DM might be explained mostly by the age at screening, but can also be associated with the screening strategy and the tests used to diagnose CD. However, the prevalence of both diseases has increased over time; thus, the variability can also be related to the time the study was performed.…”

Section: Epidemiologymentioning

confidence: 99%

“…27,28 However, a meta-analysis published in 2014 described no sex predominance in the prevalence of CD in T1DM. 16 A recent review 29 analyzed nine longitudinal cohort studies dealing with CD screening in T1DM children. The nine studies included altogether 11,157 children and adolescents with T1DM, of whom 587 had biopsy-reported CD (median follow-up 10 years).…”

Section: Epidemiologymentioning

confidence: 99%

Dietary gluten and the development of celiac disease and type 1 diabetes

Ciacci¹,

Zingone²

2016

NDS

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Abstract:The objective of this study was to perform a review of the present knowledge on the epidemiology and pathogenesis of the association between celiac disease (CD) and type 1 diabetes mellitus (T1DM). Results from this review show that the estimated prevalence rate of CD in T1DM ranges from 4% to 11.5%, which seems higher in children than in adults, while there is no sex predominance in the prevalence of CD in T1DM. On the basis of the previous literature, screening for CD should be considered at diabetes diagnosis in all subjects and again within 2 and 5 years after diagnosis, even in the absence of symptoms. The anti-islet antibodies detection test, instead, is not recommended in CD, just as in the general population, except for CD patients having a relative with T1DM. Both genes and environmental factors seem to play a role in this association. HLADQ2 has been found to be the most frequent allele in the patients with both CD and T1DM, while gluten may be considered the trigger that induces the production of autoantibodies and the development, in genetically predisposed individuals, of both diseases.

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Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes

Abstract: SUMMARY BackgroundIn the past decade, a number of population-based studies have examined the prevalence of coeliac disease in individuals with type 1 diabetes but prevalences have differed considerably.

Cited by 166 publications

References 68 publications

Celiac Disease Increases Risk of Thyroid Disease in Patients With Type 1 Diabetes: A Nationwide Cohort Study

Celiac Disease Increases Risk of Thyroid Disease in Patients With Type 1 Diabetes: A Nationwide Cohort Study

High Rate of Spontaneous Normalization of Celiac Serology in a Cohort of 446 Children With Type 1 Diabetes: A Prospective Study

Dietary gluten and the development of celiac disease and type 1 diabetes

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