Clinical and Immunological Features of Celiac Disease in Patients With Type 1 Diabetes Mellitus

Umberto Volta; Francesco Tovoli; Giacomo Caio

Disclosures

Expert Rev Gastroenterol Hepatol. 2011;5(4):479-487. 

In This Article

Follow-up of CD Patients With T1DM: Positive & Negative Effects of GFD

Once diagnosed, CD patients with T1DM should be followed up by means of a periodic check-up in the same guise as CD patients without T1DM. The main aims are:

  • To verify compliance with GFD by a dietary interview and serological assays;

  • To assess the general status of nutrition and absorption by means of blood tests;

  • To monitor the metabolic balance for the possible occurrence or worsening of a metabolic syndrome;

  • To rule out the occurrence of CD complications (refractory CD, ulcerative jejunoileitis, collagenous sprue, T-cell intestinal lymphoma).

The timing for CD follow-up includes a first check up at 6 months after the start of GFD and, later on, once a year.[63]

Gluten withdrawal in T1DM when diagnosed with CD normalizes the architecture of the small intestinal mucosa, allowing a normal absorption of nutrients.[64] Consequently, in 6–12 months the clinical picture of symptomatic subjects improves, with disappearance of iron-deficiency anemia, improvement of bone mass and growth, normalization of transaminases levels and reduction in gastrointestinal symptoms. GFD has contradictory effects on T1DM, since it is able to significantly reduce hypoglycemic episodes but it generally increases insulin needs and does not improve HBA1c levels (usually lower at the time of CD diagnosis).[8] Evaluation of the glycemic index of gluten-free foods still remains controversial. The different formulation and the food-processing procedures used in the manufacturing of gluten-free products may elicit a high glucose response.[65] According to other authors, the inclusion of gluten-free foods in the diet of T1DM should not compromise glycemic control, suggesting a normal glycemic index of gluten-free products.[66] Moreover, a renoprotective effect of gluten-free products has also been reported in patients with CD and T1DM due to lower levels of circulating advanced glycation end products related to a GFD regimen.[67]

The improvement of the small intestinal absorptive function, together with an elevated consumption of commercial gluten-free foods, particularly rich in carbohydrates and lipids, may favor the development of a metabolic syndrome with an increased BMI and high levels of cholesterol with or without high levels of transaminases (nonalcoholic steatohepatitis or nonalcoholic fatty liver disease).[68] Positive effects of GFD largely prevail over a few problems induced from the diet, also considering that a strict gluten withdrawal provides a high protection against the development of lymphoma and other, although rare, CD-related complications.[69]

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