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

Umberto Volta; Francesco Tovoli; Giacomo Caio


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

In This Article

Who Should be Treated by a GFD?

Before initiating the withdrawal of gluten in a T1DM patient, it should be considered that a GFD regimen introduces a significant change in the nutritional habits of T1DM patients, causing further problems in the social life of these patients, especially in adolescents. It should be also kept in mind that there is no documented benefit induced by GFD in patients with asymptomatic potential CD.[57] Moreover, it is relevant to underline that the compliance with GFD, reported in literature, is poor (˜50%).[58] Symptomatic patients, above all those complaining of gastrointestinal symptoms, display a strict compliance with the diet since the reintroduction of gluten is responsible for diarrhea, abdominal pain, bloating and other gastrointestinal symptoms. People with the clinically silent form of CD do not usually display a strict adherence to GFD and therefore they are at a higher risk of complications.[59] Compliance with the diet is particularly difficult to achieve in adolescents.[60] Considering these important statements, GFD should be initiated in all T1DM patients with the typical morphological lesion of CD, that is, villous atrophy, regardless of its severity, with an increased number of IEL. Both symptomatic and silent patients must be treated, since it is well known that GFD has a protective effect on neoplastic and non-neoplastic complications of CD (lymphoma, ulcerative jejunoileitis, refractory CD).[61] Complications are frequently associated with a poor outcome, but luckily they represent a rare event in the natural history of CD, being present in less than 2% of patients. As for potential CD cases, occurring more and more frequently in T1DM, the most appropriate treatment is to keep the patient on a gluten-containing diet regimen with frequent CD antibody follow-up and, in the case of antibody titer increase and appearance of symptoms, to repeat a duodenal biopsy.[62] Among potential CD cases, only those with evident symptoms indicating malabsorption such as iron-deficiency anemia, hypoalbuminemia and reduced bone mass, should be put on GFD.


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