Abstract

RAMIREZ BENITEZ, Ana Iris et al. Celiac disease and type 1 diabetes mellitus: association and clinical characteristics. Rev. virtual Soc. Parag. Med. Int. [online]. 2014, vol.1, n.1, pp.8-17. ISSN 2312-3893.  https://doi.org/10.18004/rvspmi/2312-3893/2014.01(01)08-017.

Introduction: The prevalence of coeliac disease (CD) among type 1 diabetic (T1DM) patients is around 4% with variations from 1 to 8% according to different publications being most cases asymptomatic or oligosymptomatic. The impact of CD on metabolic control is not well known yet, especially regarding to a higher predisposition to hypoglycemic events. Objectives: To determine the frequency of CD in adolescents and adults with T1DM, and relate the presence of CD with the clinical characteristics, metabolic control and hypoglycemic events. Materials and methods: This was a cross-sectional observational study carried out in 64 adolescents and adults with T1DM who were between 15 to 40 years of age without known CD. The levels of anti-transglutaminase antibodies and IgA were determined. The diagnosis of CD was based on the presence of anti-transglutaminase IgA antibodies along with the confirmation by intestinal biopsy. The presence of gastrointestinal and general symptoms, hypoglycemic events and metabolic control by HbA1c were evaluated. T1DM patients diagnosed with CD were compared with a control group of T1DM without CD and both groups were matched by age and sex. Results: Of the 64 T1DM patients, 32 were women and 32 men. Mean age was 25.1 ± 6.04 years. CD was confirmed by intestinal biopsy in 6 patients (9.37%, CI 95% 3.5 -19.3%). In relation to the clinical characteristics, only 2 of them (33.3%) presented the classic symptoms of CD. The mean HbA1c in T1DM with CD was high (10.01%), but without a significant difference with the control group (9.9%). In the group with T1DM and CD, 4 (66.7%) reported episodes of mild hypoglycemia once a week with no difference in comparison with the control group (77.8%). Conclusion: A high association was found between CD and T1DM but most of the cases were silent or with atypical presentation. Therefore, these findings support the need of a regular screening of CD in T1DM patients even in adults ones. Association was not found between CD and a bad metabolic control or with hypoglycemic events.

Keywords : type 1 diabetes mellitus; coeliac disease; metabolic control; hypoglycemia.

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