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

Epidemiology of CD in T1DM

The prevalence of CD in T1DM has been largely investigated by means of serological screening and intestinal biopsy in antibody-positive cases. Based on these studies, the prevalence of CD in T1DM ranges from 3 to 16% (Table 1).[15–22] According to the studies reported in Table 1, the mean prevalence of CD, as confirmed by duodenal biopsy, in T1DM is approximately 8% worldwide, which means it is eight-times higher than CD prevalence in the general population. The highest occurrence has been reported in a study performed in Algeria of 116 diabetic children, 19 (16.4%) of whom had a biopsy-proven CD diagnosis.[15] It has also been demonstrated that CD prevalence in T1DM has significantly increased in the decade from 1994 to 2004 in comparison with the previous decade, resulting in a threefold increased frequency in recent years compared with the past (10.6 vs 3.3%).[18] This study was performed by using frozen banked sera collected for approximately 20 years with the possibility to perform the same diagnostic tests for CD in all the samples available. The highest risk for CD among patients with T1DM that occurred in the mid-1990s may be related to changes in environmental factors, namely eating habits (higher intake of gluten) and viral infections (increasing occurrence). The appearance of CD seems to be significantly higher in children diagnosed with T1DM at a younger age (<4 years); moreover, females have a higher risk of having both CD and T1DM than males.[23] It has been demonstrated that an early diagnosis of CD diminishes the prevalence of associated autoimmune disorders including T1DM by reducing the length of gluten exposure. Conversely, a diagnostic delay in CD recognition would favour the spread of autoimmunity, again suggesting a central role of gluten in triggering immune system abnormalities.[24]

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