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Roberts RHR, Davies-Jones GR, Brock J, Satheesh V, Robertson GAJ. Surgical management of the diabetic foot: The current evidence. World J Orthop 2024; 15:404-417. [PMID: 38835689 PMCID: PMC11145970 DOI: 10.5312/wjo.v15.i5.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
The prevalence of diabetes mellitus and its associated complications, particularly diabetic foot pathologies, poses significant healthcare challenges and economic burdens globally. This review synthesises current evidence on the surgical management of the diabetic foot, focusing on the interplay between neuropathy, ischemia, and infection that commonly culminates in ulcers, infections, and, in severe cases, amputations. The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies, as diabetic foot complications are a leading cause of hospital admissions among diabetic patients, significantly impacting morbidity and mortality rates. This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers, infections, and skeletal pathologies such as Charcot arthropathy, emphasising the critical role of early diagnosis, comprehensive management strategies, and interdisciplinary care in mitigating adverse outcomes. In addressing surgical interventions, this review evaluates conservative surgeries, amputations, and reconstructive procedures, highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies. The integration of advanced diagnostic tools, novel surgical techniques, and postoperative care, including offloading and infection control, are discussed in the context of optimising healing and preserving limb function.
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Affiliation(s)
| | - Gareth Rhys Davies-Jones
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
| | - James Brock
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Vaishnav Satheesh
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Greg AJ Robertson
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
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Starcea IM, Miron I, Lupu A, Ioniuc I, Alecsa M, Azoicai A, Morariu ID, Munteanu V, Lupu VV, Mocanu A. Unraveling chronic kidney disease in children: a surprising manifestation of celiac disease. Front Pediatr 2024; 12:1384591. [PMID: 38720942 PMCID: PMC11076832 DOI: 10.3389/fped.2024.1384591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Celiac disease, firstly described in children, is a type of T-cell enteropathy that occurs in individuals genetically predisposed to gluten exposure. The estimated global prevalence of celiac disease is continuously increasing. Although, traditionally, celiac disease was diagnosed in children with failure to thrive and digestive issues, it is now recognized that may present with a wide range of symptoms beyond gastrointestinal ones. Celiac disease continues to pose significant challenges due to the continuous advancement of knowledge in understanding its pathophysiology, diagnosing the condition, managing its effects, and exploring potential therapeutic approaches. The prevalence of celiac disease is increased among individuals with chronic kidney disease, also. The most frequent associations are with diabetic nephropathy, IgA nephropathy and urolithiasis. A gut-kidney axis has been recognized to play a significant role in chronic kidney diseases. This literature review aims to review the chronic renal pathology associated with celiac disease, with emphasis on childhood.
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Affiliation(s)
- Iuliana Magdalena Starcea
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ingrith Miron
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ancuta Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ileana Ioniuc
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Mirabela Alecsa
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Alice Azoicai
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ionela Daniela Morariu
- Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Valentin Munteanu
- Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Vasile Valeriu Lupu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Adriana Mocanu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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3
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James S, Perry L, Lowe J, Donaghue KC, Pham-Short A, Craig ME. Coexisiting type 1 diabetes and celiac disease is associated with lower Hba1c when compared to type 1 diabetes alone: data from the Australasian Diabetes Data Network (ADDN) registry. Acta Diabetol 2023; 60:1471-1477. [PMID: 37338603 PMCID: PMC10520068 DOI: 10.1007/s00592-023-02113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/02/2023] [Indexed: 06/21/2023]
Abstract
AIM To compare HbA1c and clinical outcomes in adolescents and young adults with type 1 diabetes (T1D), with or without celiac disease (CD). METHODS Longitudinal data were extracted from ADDN, a prospective clinical diabetes registry. Inclusion criteria were T1D (with or without CD), ≥ 1 HbA1c measurement, age 16-25 years and diabetes duration ≥ 1 year at last measurement. Multivariable Generalised Estimated Equation models were used for longitudinal analysis of variables associated with HbA1c. RESULTS Across all measurements, those with coexisting T1D and CD had lower HbA1c when compared to those with T1D alone (8.5 ± 1.5% (69.4 ± 16.8 mmol/mol) vs. 8.7 ± 1.8% (71.4 ± 19.8 mmol/mol); p < 0.001); lower HbA1c was associated with shorter diabetes duration (B = - 0.06; 95% CI - 0.07 to - 0.05; p < 0.001), male sex (B = - 0.24; - 0.36 to - 0.11; p < 0.001), insulin pump therapy use (B = - 0.46; - 0.58 to - 0.34; p < 0.001), coexistence of T1D and CD (B = - 0.28; - 0.48 to - 0.07; p = 0.01), blood pressure (B = - 0.16; - 0.23 to - 0.09; p < 0.001) and body mass index (B = -- 0.03; - 0.02 to - 0.04; p = 0.01) in the normal range. At last measurement, 11.7% of the total population had a HbA1c < 7.0% (53.0 mmol/mol). CONCLUSIONS Across all measurements, coexisting T1D and CD is associated with lower HbA1c when compared to T1D alone. However, HbA1c is above target in both groups.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, Moreton Bay Campus, 1 Moreton Parade, Petrie, 4502, Australia.
- University of Melbourne, Parkville, Australia.
- University of Western Sydney, Campbelltown, Australia.
| | - Lin Perry
- University of Technology Sydney, Ultimo, Australia
- Prince of Wales Hospital, Randwick, Australia
| | | | - Kim C Donaghue
- Children's Hospital at Westmead, Westmead, Australia
- University of Sydney, Camperdown, Australia
| | | | - Maria E Craig
- Children's Hospital at Westmead, Westmead, Australia
- University of Sydney, Camperdown, Australia
- University of New South Wales, Kensington, Australia
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4
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Al Hayek AA, Al Zahrani WM, AlAblani HM, Al Dawish MA. Metabolic control, adherence to the gluten-free diet and quality of life among patients with type 1 diabetes and celiac disease. Diabetol Metab Syndr 2023; 15:189. [PMID: 37759325 PMCID: PMC10536816 DOI: 10.1186/s13098-023-01167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS In this cross-sectional study, we aimed to evaluate metabolic control, adherence to a gluten-free diet (GFD), and quality of life (QoL) in individuals with type 1 diabetes (T1D) and celiac disease (CD). METHODS We targeted individuals with T1D and CD at a major tertiary hospital in Saudi Arabia. We gathered retrospective data from medical records and prospectively assessed glycemic control using HbA1c and ambulatory glucose metrics, adherence to a GFD using the Celiac Dietary Adherence Test (CDAT), and QoL using the Celiac Disease Quality of Life survey (CD-QoL). RESULTS Forty-eight out of 1095 patients screened (4.38%) were included. Mean age and HbA1c were 21.3 (± 6.6) and 8.3% (± 0.8%). The average time in range% and above range% were 38.5 (range 24-68) and 29.6 (± 7.4). The median hypoglycemic events/month was 8, with a median duration of 80 min. The median overall CDAT and CD-QoL scores were 20.5 and 54. No significant correlations were observed between glucose management indicator (GMI), % in target, and CDAT/CD-QoL scores (all p > 0.05). CONCLUSIONS No significant effect of GFD on QoL or glycemic control was observed. Further prospective studies are warranted to establish solid evidence of the impact of GFD on individuals with T1D and CD.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia.
| | - Wael M Al Zahrani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Hamad M AlAblani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
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5
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Vidal MJ, Ruiz de Assin Valverde A, López García MC, Moya Moya AJ, Pinés Corrales PJ. Prevalence of celiac disease in a cohort of adult patients with type 1 diabetes. ENDOCRINOL DIAB NUTR 2023; 70:293-294. [PMID: 37061412 DOI: 10.1016/j.endien.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/08/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Marina Jara Vidal
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - María Carmen López García
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Antonio José Moya Moya
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Pedro José Pinés Corrales
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Facultad de Medicina de Albacete. Universidad de Castilla-La Mancha, Albacete, Spain.
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6
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Gluten-Free Diet in Co-Existent Celiac Disease and Type 1 Diabetes Mellitus: Is It Detrimental or Beneficial to Glycemic Control, Vascular Complications, and Quality of Life? Nutrients 2022; 15:nu15010199. [PMID: 36615856 PMCID: PMC9824312 DOI: 10.3390/nu15010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Celiac disease (CeD) is associated with type 1 diabetes mellitus (T1DM), and both have the same genetic background. Most patients with T1DM who develop CeD are either asymptomatic or have mild CeD-related gastrointestinal symptoms. Therefore, children affected by T1DM should undergo screening for asymptomatic CeD. The aim of this review is to highlight the influence of a gluten-free diet (GFD) on glycemic control, growth rate, microvascular complications, and quality of life in patients with T1DM and CeD. PubMed, Google Scholar, Web of Science, and Cochrane Central databases were searched. Reports reviewed were those published from 1969 to 2022 that focused on the interplay of T1DM and CeD and examined the effect of diet on glycemic control, growth rate, and quality of life. The most challenging aspect for a child with T1DM and CeD is that most GFD foods have a high glycemic index, while low glycemic index foods are recommended for T1DM. Interestingly, dietary therapy for CeD could improve the elevated HbA1c levels. Avoiding gluten added to a diabetic dietary regimen in T1DM patients might impose practical limitations and lead to important restrictions in the lifestyle of a young patient. Consequently, non-adherence to GFD in patients with T1DM and CeD is common. GFD in patients with T1DM and CeD seems to lower the incidence of micro- and macrovascular complications, but this requires further investigation. It seems that adherence to GFD in young patients with T1DM and CeD leads to regular growth and a stable body mass index without any negative effect on HbA1c or insulin requirements. Furthermore, the lipid profile and quality of life seem to have improved with the introduction of GFD.
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Nurmi R, Pasternack C, Salmi T, Hervonen K, Koskinen I, Järvelin J, Huhtala H, Collin P, Mustonen J, Kaukinen K, Mäkelä S. The risk of renal comorbidities in celiac disease patients depends on the phenotype of celiac disease. J Intern Med 2022; 292:779-787. [PMID: 35713926 PMCID: PMC9796855 DOI: 10.1111/joim.13532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND An increased risk of kidney disease in patients with celiac disease has been reported, but the association has remained obscure. Only few studies have investigated the association between renal comorbidities and dermatitis herpetiformis, a cutaneous manifestation of celiac disease. OBJECTIVES We investigated whether patients with different phenotypes of celiac disease are at higher risk of kidney diseases than age- and sex-matched references. METHODS The diagnoses of glomerulonephritis, diabetic nephropathy, interstitial nephritis, and end-stage renal disease obtained from the National Hospital Discharge Register between 1970 and 2015 were identified in celiac disease (Marsh III, n = 1072) and dermatitis herpetiformis (n = 368) patients diagnosed at Tampere University Hospital catchment region and in 4296 reference subjects. Using the Cox proportional hazards model, we compared the risk of kidney diseases between patients and references. The study protocol was approved by the Regional Ethics Committee of Tampere University Hospital (R16090). As the study was register based, no consent from patients was required. RESULTS Even after adjusting for type 1 diabetes, celiac disease was associated with an elevated risk of kidney disease (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.12-3.03), glomerulonephritis (HR 3.37, 95% CI 1.64-6.95), and IgA nephropathy (IgAN) (HR 18.98, 95% CI 2.29-157.63). No similarly elevated risk was found among dermatitis herpetiformis patients (HR 1.50, 95% CI 0.63-3.55; HR 2.21, 95% CI 0.77-6.38; and HR 5.87, 95% CI 0.53-64.79, respectively). CONCLUSION Celiac disease patients were at increased risk of kidney diseases, notably IgAN. The risk was dependent on the celiac disease phenotype and was not seen in patients with dermatitis herpetiformis. Awareness of possible renal manifestations is recommended when treating celiac disease patients.
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Affiliation(s)
- Rakel Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Inka Koskinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Jutta Järvelin
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pekka Collin
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Zubkiewicz-Kucharska A, Jamer T, Chrzanowska J, Akutko K, Pytrus T, Stawarski A, Noczyńska A. Prevalence of haplotype DQ2/DQ8 and celiac disease in children with type 1 diabetes. Diabetol Metab Syndr 2022; 14:128. [PMID: 36096955 PMCID: PMC9465882 DOI: 10.1186/s13098-022-00897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Type 1 diabetes (T1D) and celiac disease (CD) coexist very often. Identification of the human leukocyte antigen (HLA) DQ2/DQ8 can confirm the genetic predisposition to CD. Negative result of this test allows to exclude CD with a high probability. It was suggested that in individuals with higher risk of CD, including T1D patients, the implementation of genetic testing should reduce the number of patients requiring systematic immunological screening. The aim of this study was to analyze the prevalence of different haplotypes predisposing to CD in children and adolescents with previously diagnosed T1D. MATERIAL AND METHODS A retrospective analysis was performed on 166 T1D children (91 girls) in whom HLA DQ2/DQ8 alleles were tested. In 9.6% CD was also diagnosed. RESULTS In 12.7% both HLA DQ2/DQ8 were negative. In 87.3% patients HLA DQ2 and/or DQ8 was positive, including 27.7% patients with both haplotypes DQ2.5 and DQ8 positive. In all CD patients the disease predisposing alleles were positive, while none of the HLA DQ2/DQ8 negative children were diagnosed with CD. CONCLUSIONS The prevalence of HLA DQ2.5 and the HLA DQ2.5 / HLA DQ8 configuration is higher in patients with T1D, and CD compared to children with T1D alone. The combination of HLA DQ2 and HLA DQ8 most significantly increases the risk of developing CD. The group of HLA DQ2/DQ8 negative patients with improbable CD diagnosis, is relatively small. Most of T1D patients HLA DQ2/DQ8 positive need further regular antibody assessment. In patients with T1D, who are at high risk of developing CD, genetic testing may be considered to select those who require further systematic serological evaluation. Due to its retrospective nature, the study was not registered in the database of clinical trials and the Clinical trial registration number is not available.
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Affiliation(s)
- Agnieszka Zubkiewicz-Kucharska
- Department of Pediatric Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
| | - Tatiana Jamer
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland.
| | - Joanna Chrzanowska
- Department of Pediatric Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Akutko
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Pytrus
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Stawarski
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Noczyńska
- Department of Pediatric Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Wroclaw, Poland
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10
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Parise M, Cutruzzolà A, Scavelli FB, Carallo C, Gnasso A, Irace C. Autoimmune thyroiditis and celiac disease do not worsen endothelial function in subjects with type 1 diabetes: an observational study. Diabetol Metab Syndr 2022; 14:103. [PMID: 35870966 PMCID: PMC9308025 DOI: 10.1186/s13098-022-00877-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is frequently associated with autoimmune thyroiditis (AT) and coeliac disease (CD). Whether the coexistence of multiple autoimmune diseases increases cardiovascular risk is uncertain. We evaluated the effects of AT and CD on arterial wall thickening and endothelial function in patients with T1D. METHODS This observational study analyzed data from T1D patients regularly followed by the Diabetes Care Centre. Clinical and biochemical characteristics and micro and macrovascular complications were collected from the electronic medical records. All subjects performed Echo-Doppler to evaluate Intima-Media Thickness (IMT) of the common carotid artery (CCA) and endothelial function by the flow-mediated dilation (FMD) technique. The statistical analyses were performed by SPSS for Macintosh. Comparison between means was performed using the t-test for unpaired data and the Mann-Whitney U test. The ANalysis Of VAriance and the Tukey posthoc test were applied to compare patients with and without other autoimmune diseases, and control subjects. The p-value for statistical significance was set at p < 0.05. RESULTS A total of 110 patients were enrolled. Among these, 69 had T1D and 41 T1D and AT and or CD, of whom 33 AT, 7 CD, and 1 both AT and CD. The mean age was 35 years, mean HbA1c was 7.6%, and mean diabetes duration 18 years. The IMT of the CCA was not significantly different between T1D patients with and without concomitant autoimmune diseases (with AT and CD: right CCA 603 ± 186 µ, left 635 ± 175 µ; without AT and CD: right CCA 611 ± 176 µ, left CCA 631 ± 200 µ). FMD was also comparable between T1D groups, with AT and CD 7.9 ± 4.2%; without AT and CD 8.8 ± 4.4%. CONCLUSION Patients with T1D and concomitant AT and or CD show no worse morphological or functional vascular damage, evaluated by CCA IMT and brachial artery flow-mediated dilation, than patients with T1D alone.
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Affiliation(s)
- Martina Parise
- Department of Health Science, University Magna Græcia, Viale Europa, Località Germaneto, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | | | - Claudio Carallo
- Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Viale Europa, Località Germaneto, Catanzaro, Italy.
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11
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Shi K, Chen Y, Zhu X, Wu J, Chen J, Hu J, Sun X, Zhang J. Biscuit consumption and diabetic retinopathy incidence in adults in the United States. Diabetol Metab Syndr 2022; 14:94. [PMID: 35794635 PMCID: PMC9258145 DOI: 10.1186/s13098-022-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foods have a considerable influence on human health and were directly related to glycemic control for diabetes patients. However, little is known about the effects of biscuits, a traditional food consumed in large amounts in several countries, on diabetic retinopathy. This study aimed to explore the association between biscuit consumption and diabetic retinopathy prevalence in adults of the United States population. METHODS A cross-sectional study with 1904 participants from the National Health and Nutrition Examination Survey database were included in this population-based, cross-sectional study. The association between different consumption frequencies of biscuit and diabetic retinopathy prevalence was evaluated using a binary logistic regression model. Trend test, stratified and interaction analyses were also performed. RESULTS After possible confounders including sex, age, ethnicity, education, marital status, family poverty income ratio, smoking and alcohol consumption habit, fasting blood glucose level, hemoglobin A1c level, diagnosis of diabetes, insulin use, blood pressure, body mass index were adjusted, the participants who consumed biscuit 1-11 times a year, 1-3 times a month, and more than once a week had a 139.8% (95% confidence interval, 1.003-5.734), 182.1% (95% confidence interval, 1.106-7.191), and 236.2% (95% confidence interval, 1.335-9.844) higher risk of diabetic retinopathy prevalence, respectively, compared with those who never ate biscuit. For male, non-Hispanic, and overweight (body mass index ≥ 25 kg/m2) subgroups, the trend test demonstrated that the diabetic retinopathy prevalence significantly elevated with increased frequency of biscuit consumption (P trend = 0.021, 0.009, and 0.002, respectively). The interaction analysis suggested that no aforementioned confounders played an interactive role in the relationship between biscuit consumption and diabetic retinopathy prevalence. CONCLUSIONS The risk of diabetic retinopathy was positively associated with biscuit consumption. Moreover, for male, non-Hispanic, or overweight individuals, the risk of diabetic retinopathy significantly increased with the frequency of biscuit consumption.
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Affiliation(s)
- Ke Shi
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yuhong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xinyue Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jiali Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jing Hu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
| | - Jingfa Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Hai Ning Road, 200080, Shanghai, People's Republic of China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
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12
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Oliveira DR, Rebelo JF, Maximiano C, Gomes MM, Martins V, Meireles C, Antunes H, Martins S. HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:229-236. [PMID: 35420265 PMCID: PMC9832899 DOI: 10.20945/2359-3997000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Methods Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.
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Affiliation(s)
| | | | | | - Maria Miguel Gomes
- Faculdade de Medicina da Universidade do Minho, Braga, Portugal.,Unidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Hospital de Braga, Braga, Portugal
| | - Vânia Martins
- Serviço de Pediatria, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Carla Meireles
- Serviço de Pediatria, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal
| | - Henedina Antunes
- Unidade de Gastroenterologia, Hepatologia e Nutrição, Serviço de Pediatria e Centro Académico Clínico Hospital de Braga, Braga, Portugal.,Instituto de Investigação em Ciências da Vida e da Saúde (ICVS), ICVS/3B's-PT Laboratório Associado do Governo e Faculdade de Medicina da Universidade do Minho, Braga, Portugal
| | - Sofia Martins
- Unidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Hospital de Braga, Braga, Portugal
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13
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de Sousa Franckilin LR, Dos Santos ACPM, Freitas FEDA, Vieira IG, de Freitas Jorge CE, Neri DG, de Abreu MVC, Fonseca JK, Loffi RG, Foureaux G. Gluten: do only celiac patients benefit from its removal from the diet? FOOD REVIEWS INTERNATIONAL 2022. [DOI: 10.1080/87559129.2021.2024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Renato Guimarães Loffi
- Departamento de Ciência, Tecnologia e Inovação, Treini Biotecnologia Ltda, Belo Horizonte, Brazil
| | - Giselle Foureaux
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Nutrição, Angiogold: Medicina Integrativa, Belo Horizonte, Brazil
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14
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Zhang X, Xiao H, Fu S, Yu J, Cheng Y, Jiang Y. Investigate the genetic mechanisms of diabetic kidney disease complicated with inflammatory bowel disease through data mining and bioinformatic analysis. Front Endocrinol (Lausanne) 2022; 13:1081747. [PMID: 36726458 PMCID: PMC9884696 DOI: 10.3389/fendo.2022.1081747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with diabetic kidney disease (DKD) often have gastrointestinal dysfunction such as inflammatory bowel disease (IBD). This study aims to investigate the genetic mechanism leading to IBD in DKD patients through data mining and bioinformatics analysis. METHODS The disease-related genes of DKD and IBD were searched from the five databases of OMIM, GeneCards, PharmGkb, TTD, and DrugBank, and the intersection part of the two diseases were taken to obtain the risk genes of DKD complicated with IBD. A protein-protein interaction (PPI) network analysis was performed on risk genes, and three topological parameters of degree, betweenness, and closeness of nodes in the network were used to identify key risk genes. Finally, Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed on the risk genes to explore the related mechanism of DKD merging IBD. RESULTS This study identified 495 risk genes for DKD complicated with IBD. After constructing a protein-protein interaction network and screening for three times, six key risk genes were obtained, including matrix metalloproteinase 2 (MMP2), hepatocyte growth factor (HGF), fibroblast growth factor 2 (FGF2), interleukin (IL)-18, IL-13, and C-C motif chemokine ligand 5 (CCL5). Based on GO enrichment analysis, we found that DKD genes complicated with IBD were associated with 3,646 biological processes such as inflammatory response regulation, 121 cellular components such as cytoplasmic vesicles, and 276 molecular functions such as G-protein-coupled receptor binding. Based on KEGG enrichment analysis, we found that the risk genes of DKD combined with IBD were associated with 181 pathways, such as the PI3K-Akt signaling pathway, advanced glycation end product-receptor for AGE (AGE-RAGE) signaling pathway and hypoxia-inducible factor (HIF)-1 signaling pathway. CONCLUSION There is a genetic mechanism for the complication of IBD in patients with CKD. Oxidative stress, chronic inflammatory response, and immune dysfunction were possible mechanisms for DKD complicated with IBD.
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Affiliation(s)
- Xiaoyu Zhang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Huijie Xiao
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shaojie Fu
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Jinyu Yu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Yanli Cheng
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Yanli Cheng, ; Yang Jiang,
| | - Yang Jiang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanli Cheng, ; Yang Jiang,
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15
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Weiman DI, Mahmud FH, Clarke ABM, Assor E, McDonald C, Saibil F, Lochnan HA, Punthakee Z, Marcon MA. Impact of a Gluten-Free Diet on Quality of Life and Health Perception in Patients With Type 1 Diabetes and Asymptomatic Celiac Disease. J Clin Endocrinol Metab 2021; 106:e1984-e1992. [PMID: 33524131 DOI: 10.1210/clinem/dgaa977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Celiac disease (CD) is a common comorbidity seen in patients with type 1 diabetes (T1D) and is frequently asymptomatic. As chronic conditions requiring significant lifestyle changes, there are limited reports assessing changes in health-related quality of life (HRQoL) during transition to a gluten-free diet (GFD) in patients with T1D who are asymptomatic for CD. OBJECTIVE This work aims to prospectively assess HRQoL and health perception in children and adults with T1D and asymptomatic CD after random assignment to GFD vs usual diet. METHODS Patients with T1D aged 8 to 45 years without CD symptoms were serologically screened for CD, with positive results confirmed with intestinal biopsy. Participants were randomly assigned in an open-label fashion to a GFD or gluten-containing diet (GCD) for 12 months. Generic and diabetes-specific HRQoL and self-perceived wellness (SPW) were assessed longitudinally. RESULTS A total of 2387 T1D patients were serologically screened. CD was biopsy-confirmed in 82 patients and 51 participants were randomly assigned to a GFD (N = 27) or GCD (N = 24). Excellent adherence to the assigned diets was observed. Overall, no changes in generic (P = .73) or diabetes-specific HRQoL (P = .30), or SPW (P = .41) were observed between groups over 12 months. Hemoglobin A1c (HbA1c) and gastrointestinal symptoms were consistent predictors of HRQoL and SPW. CONCLUSION HRQoL and SPW were not significantly affected by the adoption of a GFD over 12 months, but worsened with symptom onset and increased HbA1c. Our findings indicate that transition to a GFD can be made successfully in this population without adversely affecting quality of life.
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Affiliation(s)
- Daniel I Weiman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Esther Assor
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte McDonald
- Division of Endocrinology and Metabolism, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Heather A Lochnan
- Department of Medicine and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zubin Punthakee
- Division of Endocrinology, McMaster University, Hamilton, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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16
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Singh P, Rawat A, Al-Jarrah B, Saraswathi S, Gad H, Elawad M, Hussain K, Hendaus MA, Al-Masri W, Malik RA, Al Khodor S, Akobeng AK. Distinctive Microbial Signatures and Gut-Brain Crosstalk in Pediatric Patients with Coeliac Disease and Type 1 Diabetes Mellitus. Int J Mol Sci 2021; 22:ijms22041511. [PMID: 33546364 PMCID: PMC7913584 DOI: 10.3390/ijms22041511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Coeliac disease (CD) and Type 1 diabetes mellitus (T1DM) are immune-mediated diseases. Emerging evidence suggests that dysbiosis in the gut microbiome plays a role in the pathogenesis of both diseases and may also be associated with the development of neuropathy. The primary goal in this cross-sectional pilot study was to identify whether there are distinct gut microbiota alterations in children with CD (n = 19), T1DM (n = 18) and both CD and T1DM (n = 9) compared to healthy controls (n = 12). Our second goal was to explore the relationship between neuropathy (corneal nerve fiber damage) and the gut microbiome composition. Microbiota composition was determined by 16S rRNA gene sequencing. Corneal confocal microscopy was used to determine nerve fiber damage. There was a significant difference in the overall microbial diversity between the four groups with healthy controls having a greater microbial diversity as compared to the patients. The abundance of pathogenic proteobacteria Shigella and E. coli were significantly higher in CD patients. Differential abundance analysis showed that several bacterial amplicon sequence variants (ASVs) distinguished CD from T1DM. The tissue transglutaminase antibody correlated significantly with a decrease in gut microbial diversity. Furthermore, the Bacteroidetes phylum, specifically the genus Parabacteroides was significantly correlated with corneal nerve fiber loss in the subjects with neuropathic damage belonging to the diseased groups. We conclude that disease-specific gut microbial features traceable down to the ASV level distinguish children with CD from T1DM and specific gut microbial signatures may be associated with small fiber neuropathy. Further research on the mechanisms linking altered microbial diversity with neuropathy are warranted.
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Affiliation(s)
- Parul Singh
- Research Department, Sidra Medicine, Doha 26999, Qatar or (P.S.); (A.R.); (B.A.-J.)
- College of Health & Life Sciences, Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha 24404, Qatar
| | - Arun Rawat
- Research Department, Sidra Medicine, Doha 26999, Qatar or (P.S.); (A.R.); (B.A.-J.)
| | - Bara Al-Jarrah
- Research Department, Sidra Medicine, Doha 26999, Qatar or (P.S.); (A.R.); (B.A.-J.)
| | - Saras Saraswathi
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha 26999, Qatar; (S.S.); (M.E.); (W.A.-M.); (A.K.A.)
| | - Hoda Gad
- Department Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar; (H.G.); (R.A.M.)
| | - Mamoun Elawad
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha 26999, Qatar; (S.S.); (M.E.); (W.A.-M.); (A.K.A.)
| | - Khalid Hussain
- Division of Endocrinology, Sidra Medicine, Doha 26999, Qatar;
| | | | - Wesam Al-Masri
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha 26999, Qatar; (S.S.); (M.E.); (W.A.-M.); (A.K.A.)
| | - Rayaz A. Malik
- Department Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar; (H.G.); (R.A.M.)
| | - Souhaila Al Khodor
- Research Department, Sidra Medicine, Doha 26999, Qatar or (P.S.); (A.R.); (B.A.-J.)
- Correspondence:
| | - Anthony K. Akobeng
- Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha 26999, Qatar; (S.S.); (M.E.); (W.A.-M.); (A.K.A.)
- Department Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar; (H.G.); (R.A.M.)
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17
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Current Evidence on the Efficacy of Gluten-Free Diets in Multiple Sclerosis, Psoriasis, Type 1 Diabetes and Autoimmune Thyroid Diseases. Nutrients 2020; 12:nu12082316. [PMID: 32752175 PMCID: PMC7468712 DOI: 10.3390/nu12082316] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
In this review, we summarize the clinical data addressing a potential role for gluten in multiple sclerosis (MS), psoriasis, type 1 diabetes (T1D) and autoimmune thyroid diseases (ATDs). Furthermore, data on the prevalence of celiac disease (CD) and gluten-related antibodies in the above patient groups are presented. Adequately powered and properly controlled intervention trials investigating the effects of a gluten-free diet (GFD) in non-celiac patients with MS, psoriasis, T1D or ATDs are lacking. Only one clinical trial has studied the effects of a GFD among patients with MS. The trial found significant results, but it is subject to major methodological limitations. A few publications have found beneficial effects of a GFD in a subgroup of patients with psoriasis that were seropositive for anti-gliadin or deamidated gliadin antibodies, but no effects were seen among seronegative patients. Studies on the role of gluten in T1D are contradictive, however, it seems likely that a GFD may contribute to normalizing metabolic control without affecting levels of islet autoantibodies. Lastly, the effects of a GFD in non-celiac patients with ATDs have not been studied yet, but some publications report that thyroid-related antibodies respond to a GFD in patients with concomitant CD and ATDs. Overall, there is currently not enough evidence to recommend a GFD to non-celiac patients with MS, psoriasis, ATDs or T1D.
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Abstract
Celiac disease (CD) is an immune-mediated enteropathy triggered by dietary ingestion of gluten in genetically susceptible patients. CD is often diagnosed by a "case-finding" approach of symptomatic patients. In recent times, the diagnostic paradigm has shifted to investigate patients who may be asymptomatic, but are at high risk of developing CD due to shared genetic susceptibilities. These high-risk groups include first-degree relatives of CD patients and patients with Type 1 diabetes mellitus, autoimmune thyroid disease, Down's syndrome, and Turner syndrome. Moreover, CD is often diagnosed as the cause of iron deficiency anemia or unexplained chronic diarrhea. Although screening for CD with serological tests is not recommended for the general population, it should be considered in these special populations. In this review, we explore screening for CD among high-risk groups in light of recent research and development in the CD arena.
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Affiliation(s)
- Dennis Kumral
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Virginia, 1215 Lee Street, PO Box 800708, Charlottesville, VA, 22908, USA.
| | - Sana Syed
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Virginia, MR-4 Bldg, 409 Lane Rd., Charlottesville, VA, 22908, USA
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19
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Goodwin G. Type 1 Diabetes Mellitus and Celiac Disease: Distinct Autoimmune Disorders That Share Common Pathogenic Mechanisms. Horm Res Paediatr 2020; 92:285-292. [PMID: 31593953 DOI: 10.1159/000503142] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 09/02/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The relatively common co-occurrence of type 1 diabetes (T1D) and celiac disease (CD) suggests these disorders share common pathogenic etiologies. SUMMARY T1D and CD are strongly linked to closely related high-risk human lymphocyte antigens (HLA-DR-DQ). High-risk HLA molecules bind specific fragments of gluten or the islet self-antigen(s) and present these antigens to antigen-responsive T cells. In an appropriate proinflammatory environment, the autoimmune response results in destruction of the intestinal enterocyte and/or the pancreatic beta cell. Environmental factors have been implicated in the etiology of T1D and CD because (1) identical twins are only partially concordant for these disorders and (2) incidence rates of T1D and CD have been steadily rising for decades. Prospective studies in infants genetically predisposed to T1D and CD showed that antibody positivity to both disorders begins in the first 1-3 years of life. Viral infections and early exposure to gluten or cow's milk in the infant diet have been implicated in disease pathogenesis. However, delaying introduction of gluten in the infant diet until 12 months of age had no impact on the development of islet or celiac autoimmunity. Weaning nursing infants to hydrolyzed infant formula had no impact on the development of T1D. Viral infections have been suspected of playing a role in T1D pathogenesis for decades. A large international prospective study (TEDDY) has shown increased risk of T1D autoimmunity particularly when >5 respiratory infections or febrile infections have occurred in the 9 months preceding the appearance of islet antibodies. Provocative data in animal models of T1D suggest the microbiome may play an important role in the pathogenesis of T1D. Breastfeeding, diet, infections, antibiotics, and method of birth alter the composition of the microbiome. Human data indicate subtle differences in the microbiome of children with T1D autoimmunity, while intestinal dysbiosis has been clearly demonstrated in CD. Alterations of the integrity of the intestinal mucosa plays an important role in the pathogenesis of CD, and the NOD mouse model suggests an important role of a leaky intestinal epithelium in T1D as well. Key Message: Immunogenetics and the environment are closely interrelated in the pathogenesis of T1D and CD. Large well-designed prospective studies in at-risk populations informed by scientifically rigorous studies in animal models are likely to have the greatest impact on our understanding of the complex pathogenesis of these detrimental autoimmune disorders.
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Affiliation(s)
- Gregory Goodwin
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA,
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20
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Sahin Y, Cakir MD, Isakoca M, Aydin Sahin D. Prevalence of Celiac Disease in Children with Type 1 Diabetes Mellitus in the South of Turkey. IRANIAN JOURNAL OF PEDIATRICS 2019; 30. [DOI: 10.5812/ijp.97306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 08/29/2023]
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21
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Connan V, Marcon MA, Mahmud FH, Assor E, Martincevic I, Bandsma RH, Vresk L, Walsh CM. Online education for gluten-free diet teaching: Development and usability testing of an e-learning module for children with concurrent celiac disease and type 1 diabetes. Pediatr Diabetes 2019; 20:293-303. [PMID: 30652421 DOI: 10.1111/pedi.12815] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/04/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Celiac disease (CD), the most common genetically-based food intolerance, affects 3% to 16% of children with type 1 diabetes (T1D). Treatment involves lifelong adherence to a gluten-free diet (GFD). Individualized dietary education is resource-intensive. We, therefore, sought to develop and test the usability of an e-learning module aimed at educating patients and caregivers regarding implementation of the GFD in children with concurrent CD and T1D. METHODS An interactive e-learning module was developed based on extensive review of CD, T1D, and educational literature. A mixed-methods usability testing approach was used to refine and evaluate the module, using qualitative semi-structured interviews, observations, and satisfaction and knowledge questionnaires in two iterative cycles. The module was refined based on themes identified from each usability cycle. RESULTS Eighteen patients (8 in cycle 1, 10 in cycle 2) and 15 caregivers (7 in cycle 1, 8 in cycle 2) participated. Patient participants had CD and T1D for a mean (SD) of 6.1 ± 5.1 and 8.3 ± 5.5 years, respectively. Their mean age was 13.5 ± 4.5 years. Thematic analysis of usability interviews showed the module to be appealing and resulted in minor module revisions after each cycle to improve usability. Mean satisfaction scores post-module completion were high (4.67 ± 0.54), indicating participants were "very satisfied" with the education. Knowledge test scores increased significantly from pre- to post-module completion (P = 0.001). CONCLUSION A multifaceted user-centered usability approach demonstrated that an innovative, interactive e-learning module is effective in knowledge retention and can provide comprehensive and accessible information in the implementation of the GFD teaching in children with CD and T1D.
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Affiliation(s)
- Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Esther Assor
- Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Inez Martincevic
- Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert H Bandsma
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Laura Vresk
- Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,The Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,The Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
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22
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Krupa-Kozak U, Lange E. The Gluten-Free Diet and Glycaemic Index in the Management of Coeliac Disease Associated with Type 1 Diabetes. FOOD REVIEWS INTERNATIONAL 2019. [DOI: 10.1080/87559129.2019.1584902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Urszula Krupa-Kozak
- Department of Chemistry and Biodynamics of Food, Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Olsztyn, Poland
| | - Ewa Lange
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Warszawa, Poland
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Walker MD, Zylberberg HM, Green PHR, Katz MS. Endocrine complications of celiac disease: a case report and review of the literature. Endocr Res 2019; 44:27-45. [PMID: 30198791 DOI: 10.1080/07435800.2018.1509868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this article is to review recent literature regarding endocrine disorders related to celiac disease (CD). METHODS We describe a case report and review existing literature on the endocrine manifestations of CD. RESULTS CD is an autoimmune disorder characterized by intestinal inflammation in response to gluten. CD can cause a wide range of extra-intestinal complications, including endocrine manifestations. Metabolic bone disease including osteoporosis and osteopenia, vitamin D deficiency, secondary hyperparathyroidism and less frequently osteomalacia can be seen. In CD, fracture risk is increased by 30-40%, while risk for hip fracture is approximately doubled. The risk for other endocrine disorders, particularly autoimmune endocrinopathies, is also increased in those with CD compared to the general population. Epidemiologic data indicate the risk for hypothyroidism is 3-4 times higher among those with CD, while risk of type 1 diabetes is greater than double. Risk for primary adrenal insufficiency is a striking 11-fold higher in those with versus without CD, though the absolute risk is low. Fertility is reduced in women with CD before diagnosis by 37% while male fertility in the absence of hypogonadism does not appear to be affected. Other endocrine conditions including hyperthyroidism, ovarian failure, androgen insensitivity, impaired growth and growth hormone deficiency and autoimmune polyendocrine syndromes have also been associated with CD. CONCLUSIONS CD is associated with a wide range of endocrine manifestations.
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Affiliation(s)
- Marcella D Walker
- a Department of Medicine , Columbia University , New York , NY , USA
| | | | - Peter H R Green
- a Department of Medicine , Columbia University , New York , NY , USA
| | - Michael S Katz
- c Department of Medicine , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
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Ludvigsson JF, Lashkariani M. Cohort profile: ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden). Clin Epidemiol 2019; 11:101-114. [PMID: 30679926 PMCID: PMC6336132 DOI: 10.2147/clep.s191914] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The ESPRESSO study constitutes a novel approach to examine the etiology and prognosis of gastrointestinal disease in which histopathology plays a prominent role. Between 2015 and 2017, all pathology departments (n=28) in Sweden were contacted and asked to procure histopathology record data from the gastrointestinal tract (pharynx to anus), liver, gallbladder, and pancreas. For each individual, local histopathology IT personnel retrieved data on personal identity number, date of histopathology, topography (where the biopsy is taken), morphology (biopsy appearance), and where available free text. In total, between 1965 and 2017, histopathology record data were available in 2.1 million unique individuals, but the number of data entries was 6.1 million because more than one biopsy was performed in many of the study participants. Index individuals with histopathology data were matched with up to five controls from the general population. We also identified all first-degree relatives (parents, children, full siblings), and the index individual's first spouse. The total study population consisted of 13.0 million individuals. Data from all the study participants have been linked to Swedish National Healthcare Registers allowing research not only on such aspects as fetal and perinatal conditions and the risk of future gastrointestinal disease but also on the risk of comorbidity and complications (including cancer and death). Furthermore, the ESPRESSO database allows researchers and practitioners to identify diagnoses and disease phenotypes not currently indexed in national registers (including disease precursors). The ESPRESSO database increases the sensitivity and specificity of already-recorded diseases in the national health registers. This paper is an overview of the ESPRESSO database.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, .,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden, .,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK, .,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA,
| | - Mariam Lashkariani
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
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Oujamaa I, Sebbani M, Elmoumou L, Bourrahouate A, El Qadiry R, El Moussaoui S, Ait Sab I, Sbihi M, Ennazk L, El Mghari-Tabib G, El Ansari N, Baizri H, Amine M, Admou B. The Prevalence of Celiac Disease-Specific Auto-Antibodies in Type 1 Diabetes in a Moroccan Population. Int J Endocrinol 2019; 2019:7895207. [PMID: 31641352 PMCID: PMC6770330 DOI: 10.1155/2019/7895207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/20/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We aimed to determine the prevalence of specific auto-antibodies to celiac disease (CD) in Moroccan type 1 diabetic (T1D) patients and compare the clinical and biological characteristics of seropositive and seronegative cases. PATIENTS AND METHODS A cross-sectional study was carried out on 276 T1D patients including 109 adults and 167 pediatric cases. The screening for CD was performed by an Elisa IgA anti-tissue transglutaminase antibody (tTGA) testing, combined with IgA quantification by nephelometry. Positive-IgA-tTGA cases were secondly tested for anti-endomysial antibodies (EMA) using an immunofluorescence technique, and the IgA deficiency cases were screened for IgG-tTGA. Patients with low positive tTGA titers underwent HLA-DQ2/DQ8 typing. Sociodemographic and clinical data of the patients were collected using a hetero-administered questionnaire. The comparison of clinical and biological data between seropositive and seronegative diabetics was done using independent T, Mann-Whitney U, chi-squared, and Fisher tests, which were considered significant if p value <0.05. RESULTS The prevalence of CD-specific auto-antibodies was estimated to be 9.1% (IC = 95%), with 25 positive cases in tTGA and EMA testing. Eight cases displayed low titers of IgA-tTGA, among which 4 were positive for HLA-DQ2, 1 for HLA-DQ8, and 1 for both DQ2 and DQ8. The other 2 cases had a biopsy-proven CD. Compared to seronegative patients, seropositive cases had a higher percentage of associated autoimmune disorders (16% vs. 2.4%, p=0.008), with a significant lower height Z-scores (median: -0.90 (-3.93 to 0.95) vs. -0.51 (-4.54 to 2.18), p=0.029) and a higher HbA1c level (median: 11.30% (7.31 to 16.00) vs. 9.30% (4.40 to17.31), p=0.022). CONCLUSION The current study gave evidence of a high prevalence of CD specific auto-antibodies in T1D population. The co-existence of these two conditions was associated with a poor glycemic control, a lower height, and other autoimmune diseases. These findings may suggest the necessity of a systematic screening of CD in T1D patients.
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Affiliation(s)
- Ider Oujamaa
- Laboratory of Immunology, University Hospital of Marrakech, Marrakech, Morocco
| | - Majda Sebbani
- Department of Public Health and Epidemiology, PCIM Research Laboratory, Cadi Ayyad University, Marrakech, Morocco
| | - Lahcen Elmoumou
- Laboratory of Immunology, University Hospital of Marrakech, Marrakech, Morocco
| | - Aïcha Bourrahouate
- Department of Pediatrics, University Hospital of Marrakech, Marrakech, Morocco
| | - Rabiy El Qadiry
- Department of Pediatrics, University Hospital of Marrakech, Marrakech, Morocco
| | | | - Imane Ait Sab
- Department of Pediatrics, University Hospital of Marrakech, Marrakech, Morocco
| | - Mohamed Sbihi
- Department of Pediatrics, University Hospital of Marrakech, Marrakech, Morocco
| | - Laila Ennazk
- Department of Endocrinology, University Hospital of Marrakech, Marrakech, Morocco
| | | | - Nawal El Ansari
- Department of Endocrinology, University Hospital of Marrakech, Marrakech, Morocco
| | - Hicham Baizri
- Department of Endocrinology, Ibn Sina Military Hospital, Marrakech, Morocco
| | - Mohamed Amine
- Department of Public Health and Epidemiology, PCIM Research Laboratory, Cadi Ayyad University, Marrakech, Morocco
| | - Brahim Admou
- Laboratory of Immunology, University Hospital of Marrakech, Marrakech, Morocco
- ERCIM Research Team, Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Williams KV, Cristaldi CL, Miller RG, Arena VC, Libman I, Huang Y, Becker DJ, Orchard TJ. Celiac Autoimmunity Is Associated With Lower Blood Pressure and Renal Risk in Type 1 Diabetes. J Clin Endocrinol Metab 2018; 103:3828-3836. [PMID: 30099548 PMCID: PMC6179181 DOI: 10.1210/jc.2018-00908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/01/2018] [Indexed: 02/07/2023]
Abstract
CONTEXT Though the long-term consequences of celiac disease (CD) in type 1 diabetes are unclear, CD has been associated with increased prevalence of end-stage renal disease (ESRD) independent of type 1 diabetes. OBJECTIVE We evaluated whether celiac autoimmunity is related to the cumulative incidence of microalbuminuria [albumin excretion rate (AER) 20 to 200 µg/min], macroalbuminuria (AER >200 µg/min), and ESRD. DESIGN, PATIENTS, AND METHODS In the prospective follow-up of the Pittsburgh Epidemiology of Diabetes Complications study of childhood-onset type 1 diabetes, 618 participants were screened for tissue transglutaminase (tTG) antibodies with a clinical assay. Nephropathy outcomes were determined at 25 years of diabetes duration. RESULTS Overall, the 33 subjects (5.3%) with strongly positive tTG levels (≥3 times the upper limit of normal) or a reported clinical history of CD had lower baseline blood pressure and lipid values. At 25 years of diabetes duration, a lower cumulative incidence of macroalbuminuria in strongly positive subjects compared with those with negative serology (3.6% vs 30.0%; P = 0.003) remained significant after adjustment for age, HbA1c, lipid measures, and blood pressure (adjusted P = 0.004). No considerable differences between these subjects and tTG-negative groups were found for microalbuminuria (40.0% vs 57.1%) or ESRD (0 vs 4.1%). CONCLUSIONS These findings show that strongly positive celiac autoimmunity status in individuals with childhood-onset type 1 diabetes is associated with lower baseline blood pressure and cholesterol measurements as well as lower macroalbuminuria risk after 25 years of type 1 diabetes duration with no increase in the risk of microalbuminuria or ESRD.
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Affiliation(s)
- Katherine V Williams
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Correspondence and Reprint Requests: Katherine V. Williams, MD, MPH, University of Pittsburgh, DLR Building, 3512 Fifth Avenue, Pittsburgh, Pennsylvania 15213. E-mail
| | - Christina L Cristaldi
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rachel G Miller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vincent C Arena
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ingrid Libman
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yihe Huang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dorothy J Becker
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Creanza A, Lupoli R, Lembo E, Tecce N, Della Pepa G, Lombardi G, Riccardi G, Di Bonito P, Capaldo B. Glycemic control and microvascular complications in adults with type 1 diabetes and long-lasting treated celiac disease: A case-control study. Diabetes Res Clin Pract 2018; 143:282-287. [PMID: 30075178 DOI: 10.1016/j.diabres.2018.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/09/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Abstract
AIMS To investigate whether in type 1 diabetes (T1DM) patients the concomitance of long-lasting celiac disease (CD) treated with a gluten free diet (GFD) impacts glycaemic control and the prevalence/severity of microvascular complications. METHODS A case-control, observational study was performed in 34 patients with T1DM and GFD-treated CD and 66 patients with T1DM alone matched for age, gender, and T1DM duration. Anthropometric parameters, glucose control (HbA1c), status of chronic complications and concomitant autoimmune diseases were evaluated. RESULTS HbA1c level was similar in T1DM + CD and T1DM alone (7.8 ± 1.0 vs 7.7 ± 1.1%, P = 0.57); insulin requirement was significantly higher in T1DM + CD compared with T1DM (P = 0.04). There were no differences in systolic blood pressure while diastolic blood pressure was significantly lower in T1DM + CD (P = 0.003). The prevalence/severity of microvascular complications was similar between the two groups. Glomerular filtration rate (eGFR) was significantly lower in T1DM + CD (100 ± 20 vs 110 ± 16 ml/min/1.73 m2, P = 0.007). CONCLUSIONS In patients with T1DM, the co-occurrence of long-term GFD-treated CD neither worsens glycemic control nor negatively impacts chronic microvascular complications. However, patients with T1DM + CD have lower eGFR values than those with T1DM alone.
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Affiliation(s)
- Annalisa Creanza
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Erminia Lembo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Nicola Tecce
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gianluca Lombardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Procolo Di Bonito
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
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Abstract
OBJECTIVE Both type 1 diabetes (T1D) and celiac disease (CD) have been linked to an increased risk of neuropathy. This study examined the risk of neuropathy in patients with T1D compared with patients with both T1D and CD. METHODS In a nationwide population-based cohort, T1D was defined as having a diagnosis of diabetes between 1964 and 2009 recorded in the Swedish National Patient Register in individuals ≤30 years of age. CD was defined as having villous atrophy (Marsh histopathology stage III) on small intestinal biopsy. CD cases were identified through biopsies examined between 1969 and 2008 at any of Sweden's 28 pathology departments. Nine hundred fifty-eight patients had both T1D and CD and were matched for sex, age, and calendar period with 4590 controls who only had T1D. Through Cox regression analysis, with CD as the time-dependent covariate, we estimated the risk of neuropathy in T1D patients with CD. RESULTS Fifty-four individuals with T1D and CD had later neuropathy (expected: n = 42). This corresponded to an adjusted hazard ratio of 1.27 (95% confidence interval = 0.95-1.71) compared with those who had T1D alone. The hazard ratio was statistically significant in the first 5 years with CD (1.67; 95% confidence interval = 1.13-2.47) but decreased to neutrality thereafter. Risk estimates were similar in men and women, and did not differ by age at CD onset. CONCLUSIONS CD does not seem to influence the risk of neuropathy in individuals with T1D, although a small excess risk cannot be ruled out.
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Thong EP, Wong P, Dev A, Ebeling PR, Teede HJ, Milat F. Increased prevalence of fracture and hypoglycaemia in young adults with concomitant type 1 diabetes mellitus and coeliac disease. Clin Endocrinol (Oxf) 2018; 88:37-43. [PMID: 28960394 DOI: 10.1111/cen.13488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/31/2017] [Accepted: 09/25/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Both Type 1 diabetes mellitus (T1DM) and coeliac disease (CD) are independently associated with reduced bone mineral density (BMD) and increased fracture risk. Whilst poorer glycaemic control and increased microvascular complications have been described, the literature examining bone health and fractures in adults with concomitant T1DM and CD (T1DM + CD) is limited. OBJECTIVE To evaluate fracture prevalence and explore associations with glycaemic control, hypoglycaemia and microvascular disease in T1DM + CD compared with T1DM alone. METHODS We conducted a retrospective cross-sectional study of young adults with T1DM, who attended diabetes clinics at a large tertiary referral centre between August 2016 and February 2017. Clinical information, radiological and biochemistry results were extracted from medical records. Patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism were excluded. RESULTS A total of 346 patients with T1DM alone (median age 23 years) and 49 patients with T1DM + CD (median age 24 years) were included. Median age, gender distribution, BMI, haemoglobin A1c, daily insulin dose and serum 25-hydroxyvitamin D levels were similar between groups. Higher adjusted fracture risk was observed in T1DM + CD compared with T1DM (12.2% vs 3.5%; OR 3.50, 95% CI 1.01-12.12, P = .01), yet BMD was only measured in 6% of patients. The adjusted risk of hypoglycaemia ≥2/week was greater for T1DM + CD (55% vs 38%, OR 3.28, 95% CI 1.61-6.69, P = .001); however, this was not independently associated with fractures. Replete vitamin D (≥ 50 nmol/L) was associated with less hypoglycaemia (OR 0.48, 95% CI 0.29-0.80; P = .005), but not with fractures. CONCLUSIONS Coeliac disease status was independently associated with increased fracture prevalence in young adults with T1DM. Recurrent hypoglycaemia was also increased in T1DM + CD, although hypoglycaemia was not independently associated with fractures. Prospective studies are required to determine the long-term impacts of CD on bone health and glycaemic control in patients with T1DM.
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Affiliation(s)
- Eleanor P Thong
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Vic., Australia
- Monash Centre for Research & Health Implementation, Clayton, Vic., Australia
| | - Phillip Wong
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, Clayton, Vic., Australia
| | - Peter R Ebeling
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Vic., Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic., Australia
| | - Helena J Teede
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Vic., Australia
- Monash Centre for Research & Health Implementation, Clayton, Vic., Australia
| | - Frances Milat
- Departments of Endocrinology and Diabetes, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
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Leeds JS, Hadjivassiliou M, Tesfaye S, Sanders DS. Lower gastrointestinal symptoms are associated with worse glycemic control and quality of life in type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2018; 6:e000514. [PMID: 29892338 PMCID: PMC5992466 DOI: 10.1136/bmjdrc-2018-000514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/13/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Lower gastrointestinal symptoms are not well characterized in people with type 1 diabetes, and the effects on quality of life and glycemic control are unknown. This study aimed to determine the prevalence of lower gastrointestinal symptoms and the effects on glycemic control and quality of life, and to investigate for underlying causes. RESEARCH DESIGN AND METHODS This is a prospective, cohort study in secondary care. Patients with type 1 diabetes completed a gastrointestinal symptom questionnaire and the Short Form 36 V.2 quality of life questionnaire and had their hemoglobin A1c measured. Patients with diarrhea were offered reassessment and investigation as per the national guidelines. Controls without diabetes were used to compare symptom prevalence and quality of life scores. RESULTS 706 with type 1 diabetes (mean age 41.9 years) and 604 controls (mean age 41.9 years) were enrolled. Gastrointestinal symptoms were significantly more frequent in type 1 diabetes compared with controls, in particular constipation (OR 2.4), diarrhea (OR 2.5), alternating bowel habit (OR 2.1), abdominal pain (OR 1.4), floating stools (OR 2.7), bloating (OR 1.4) and flatulence (OR 1.3) (all p<0.05). Previous pancreatitis was more frequent in type 1 diabetes (OR 4.6), but other gastrointestinal conditions were not. Gastrointestinal symptoms were associated with poorer glycemic control (p<0.01) and worse quality of life particularly in those with diarrhea. Investigation of those with diarrhea, including those with alternating bowel habit, (n=105), identified a cause in 72.3% with subsequent change in management. CONCLUSIONS Gastrointestinal symptoms are twice as common in type 1 diabetes and associated with poorer quality of life and glycemic control. Investigation of diarrhea in people with type 1 diabetes leads to a high yield of treatable conditions and a change in management in about three-quarters.
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Affiliation(s)
- John S Leeds
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Solomon Tesfaye
- Department of Diabetes, Royal Hallamshire Hospital, Sheffield, UK
| | - David S Sanders
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK
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Salardi S, Maltoni G, Zucchini S, Iafusco D, Zanfardino A, Confetto S, Toni S, Zioutas M, Marigliano M, Cauvin V, Franceschi R, Rabbone I, Predieri B, Schiaffini R, Salvatoni A. Whole lipid profile and not only HDL cholesterol is impaired in children with coexisting type 1 diabetes and untreated celiac disease. Acta Diabetol 2017. [PMID: 28639064 DOI: 10.1007/s00592-017-1019-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS Low HDL cholesterol (HDL-C) levels have been described in patients with coexisting type 1 diabetes mellitus (T1DM) and celiac disease (CD). Data on other possible lipid abnormalities that could further increase cardiovascular risk in these patients are scarce and incomplete. Aim of this retrospective multicenter study was to evaluate whole lipid profiles, besides HDL-C, in children with T1DM associated with biopsy-proven CD, and to investigate the influence of age and degree of adherence to gluten-free diet (GFD) on lipid changes. METHODS A total of 261 children with both T1DM and CD were enrolled. Serum lipid profiles at CD diagnosis were compared with those after 1 year of GFD and with those of 224 matched children with T1DM alone. The adherence to GFD was judged by means of CD-related antibodies. RESULTS At CD diagnosis, children with T1DM + CD showed higher LDL cholesterol (LDL-C) compared to children with T1DM alone. Gluten withdrawal failed to normalize LDL-C levels, not even in completely adherent individuals. HbA1c values were not influenced by GFD. The youngest children were characterized at diagnosis by lower levels of total cholesterol and on treatment by a greater decrease in triglycerides levels. CONCLUSIONS An unfavorable lipid profile, characterized not only by low HDL-C levels but also by high LDL-C values, may increase the risk of cardiovascular disease in children with T1DM and untreated CD. Therefore, a strict gluten-free diet is mandatory in these children, especially the youngest.
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Affiliation(s)
- Silvana Salardi
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Dario Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Angela Zanfardino
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Santino Confetto
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Sonia Toni
- Meyer Pediatric Institute, University of Firenze, Florence, Italy
| | - Maximiliano Zioutas
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy
| | - Marco Marigliano
- Department of Life and Reproduction Sciences, Regional Center for Pediatric Diabetes, Clinical Nutrition and Obesity, University of Verona, Verona, Italy
| | | | | | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Ciaccio EJ, Lewis SK, Biviano AB, Iyer V, Garan H, Green PH. Cardiovascular involvement in celiac disease. World J Cardiol 2017; 9:652-666. [PMID: 28932354 PMCID: PMC5583538 DOI: 10.4330/wjc.v9.i8.652] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/13/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is an autoimmune response to ingestion of gluten protein, which is found in wheat, rye, and barley grains, and results in both small intestinal manifestations, including villous atrophy, as well as systemic manifestations. The main treatment for the disease is a gluten-free diet (GFD), which typically results in the restoration of the small intestinal villi, and restoration of other affected organ systems, to their normal functioning. In an increasing number of recently published studies, there has been great interest in the occurrence of alterations in the cardiovascular system in untreated CD. Herein, published studies in which CD and cardiovascular terms appear in the title of the study were reviewed. The publications were categorized into one of several types: (1) articles (including cohort and case-control studies); (2) reviews and meta-analyses; (3) case studies (one to three patient reports); (4) letters; (5) editorials; and (6) abstracts (used when no full-length work had been published). The studies were subdivided as either heart or vascular studies, and were further characterized by the particular condition that was evident in conjunction with CD. Publication information was determined using the Google Scholar search tool. For each publication, its type and year of publication were tabulated. Salient information from each article was then compiled. It was determined that there has been a sharp increase in the number of CD - cardiovascular studies since 2000. Most of the publications are either of the type "article" or "case study". The largest number of documents published concerned CD in conjunction with cardiomyopathy (33 studies), and there have also been substantial numbers of studies published on CD and thrombosis (27), cardiovascular risk (17), atherosclerosis (13), stroke (12), arterial function (11), and ischemic heart disease (11). Based on the published research, it can be concluded that many types of cardiovascular issues can occur in untreated CD patients, but that most tend to resolve on a GFD, often in conjunction with the healing of small intestinal villous atrophy. However, in some cases the alterations are irreversible, underscoring the need for CD screening and treatment when cardiovascular issues arise of unknown etiology.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
| | - Suzanne K Lewis
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
| | - Angelo B Biviano
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
| | - Vivek Iyer
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
| | - Peter H Green
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
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35
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Affiliation(s)
- Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Department of Pediatrics; Örebro University Hospital; Örebro Sweden
- Division of Epidemiology and Public Health; School of Medicine; University of Nottingham, City Hospital; Nottingham UK
- Department of Medicine; Celiac Disease Center; Columbia University College of Physicians and Surgeons; New York NY USA
| | - Benjamin Lebwohl
- Department of Medicine; Celiac Disease Center; Columbia University College of Physicians and Surgeons; New York NY USA
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Celiac disease and the risk of kidney diseases: A systematic review and meta-analysis. Dig Liver Dis 2016; 48:1418-1424. [PMID: 27633269 DOI: 10.1016/j.dld.2016.08.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/06/2016] [Accepted: 08/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Previous epidemiologic studies attempting to demonstrate the risk of kidney diseases among patients with celiac disease (CD) have yielded inconsistent results. This meta-analysis was conducted with the aims to summarize all available evidence. METHODS A literature search was performed using MEDLINE and EMBASE from inception to May 2016. Studies that provided relative risks, odd ratios, or hazard ratios examining the risk of kidney diseases among patients with CD versus individuals without CD were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS Eight studies met our eligibility criteria and were included in our analysis. A pooled RR of overall kidney diseases in patients with CD was 2.01 (95% CI, 1.44-2.81, I2=76%). The pooled RR of end-stage renal disease in patients with CD was 2.57 (95% CI, 2.03-3.24). Subgroup analyses showed that significant risks were increased for diabetic nephropathy (pooled RR of 1.49, 95% CI, 1.09-2.02) and IgA nephropathy (pooled RR of 2.62, 95% CI, 1.27-5.42) in patients with CD. CONCLUSIONS Our study demonstrates a significantly increased risk of kidney diseases among patients with CD. These findings may influence clinical management and primary prevention of kidney diseases in patients with CD.
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Salardi S, Maltoni G, Zucchini S, Iafusco D, Confetto S, Zanfardino A, Toni S, Piccini B, Zioutas M, Marigliano M, Cauvin V, Franceschi R, Rabbone I, Predieri B, Schiaffini R, Salvatoni A, Reinstadler P, Berioli G, Cherubini V, d'Annunzio G. Celiac Disease Negatively Influences Lipid Profiles in Young Children With Type 1 Diabetes: Effect of the Gluten-Free Diet. Diabetes Care 2016; 39:e119-20. [PMID: 27271186 DOI: 10.2337/dc16-0717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/04/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Silvana Salardi
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Dario Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Santino Confetto
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Angela Zanfardino
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Sonia Toni
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Barbara Piccini
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Maximiliano Zioutas
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Marigliano
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | | | | | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Palidoro Unit, University Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Giulia Berioli
- Department of Gynaecological, Obstetric and Paediatric Sciences, University of Perugia, Perugia, Italy
| | - Valentino Cherubini
- Division of Paediatric Diabetes in Children and Adolescents, Maternal-Infantile Department, Salesi Hospital, Ancona, Italy
| | - Giuseppe d'Annunzio
- Department of Pediatrics, IRCCS Gaslini Children's Hospital, University of Genova, Genova, Italy
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Warncke K, Liptay S, Fröhlich-Reiterer E, Scheuing N, Schebek M, Wolf J, Rohrer TR, Meissner T, Holl RW. Vascular risk factors in children, adolescents, and young adults with type 1 diabetes complicated by celiac disease: results from the DPV initiative. Pediatr Diabetes 2016; 17:191-8. [PMID: 25677756 DOI: 10.1111/pedi.12261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/28/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Celiac disease (CD) is a common comorbidity of type 1 diabetes (T1D). Long-term consequences of CD are not completely understood, and adhering to a gluten-free diet is a burden for many patients. We investigated the effect of CD on vascular risk factors in a large cohort of T1D patients aged <20 yr. RESEARCH DESIGN AND METHODS Within the longitudinal Diabetes Patienten Verlaufsdokumentation (DPV)-diabetes registry, data were analyzed from 59,909 < 20-yr-old T1D patients treated at 392 centers in Germany and Austria. A total of 974 patients with biopsy-proven celiac disease (BPCD) were compared with 28,398 patients without CD with respect to blood pressure (BP), lipids, glycohemoglobin (HbA1c ), body mass index (BMI), and reported smoking behavior. RESULTS Patients with T1D and BPCD showed significantly lower high-density lipoprotein (HDL) cholesterol levels [median (interquartile range): 53.0 (43.0-62.6) mg/dL] than patients without CD [55.0 (45.0-66.0) mg/dL; p < 0.01; p < 0.001 after adjustment for confounding variables]. Systolic BP was lower in patients with CD [105.5 (100.0-112.5) mmHg] than in patients without CD [110.0 (102.0-117.0) mmHg; p < 0.0001; p < 0.001 after adjustment]. There were no significant differences regarding smoking behavior, BMI, or HbA1c . In a subgroup of 335 patients with BPCD, HDL cholesterol was measured 1 yr after diagnosis of CD:HDL increased by 8% (p < 0.01). CONCLUSION Young people with T1D and CD have lower HDL cholesterol values than patients without CD. As low HDL cholesterol is associated with vascular risk, our findings support screening for CD and monitoring of HDL cholesterol in young people with T1D.
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Affiliation(s)
- Katharina Warncke
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.,Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Susanne Liptay
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
| | - Martin Schebek
- Department of children's diabetology, Children's Hospital Klinikum Kassel, Kassel, Germany
| | | | - Tilman R Rohrer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
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Garcia-Quintanilla A, Miranzo-Navarro D. Extraintestinal manifestations of celiac disease: 33-mer gliadin binding to glutamate receptor GRINA as a new explanation. Bioessays 2016; 38:427-39. [PMID: 26990286 DOI: 10.1002/bies.201500143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We propose a biochemical mechanism for celiac disease and non-celiac gluten sensitivity that may rationalize many of the extradigestive disorders not explained by the current immunogenetic model. Our hypothesis is based on the homology between the 33-mer gliadin peptide and a component of the NMDA glutamate receptor ion channel - the human GRINA protein - using BLASTP software. Based on this homology the 33-mer may act as a natural antagonist interfering with the normal interactions of GRINA and its partners. The theory is supported by numerous independent data from the literature, and provides a mechanistic link with otherwise unrelated disorders, such as cleft lip and palate, thyroid dysfunction, restless legs syndrome, depression, ataxia, hearing loss, fibromyalgia, dermatitis herpetiformis, schizophrenia, toxoplasmosis, anemia, osteopenia, Fabry disease, Barret's adenocarcinoma, neuroblastoma, urinary incontinence, recurrent miscarriage, cardiac anomalies, reduced risk of breast cancer, stiff person syndrome, etc. The hypothesis also anticipates better animal models, and has the potential to open new avenues of research.
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Affiliation(s)
| | - Domingo Miranzo-Navarro
- Department of Biochemistry and Molecular Biology, School of Pharmacy, University of Seville, Spain
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De Melo EN, Deda L, Har R, Reich HN, Scholey JW, Daneman D, Moineddin R, Motran L, Elia Y, Cherney DZI, Sochett EB, Mahmud FH. The urinary inflammatory profile in gluten free diet-adherent adolescents with type 1 diabetes and celiac disease. J Diabetes Complications 2016; 30:295-9. [PMID: 26790575 DOI: 10.1016/j.jdiacomp.2015.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/28/2015] [Accepted: 11/23/2015] [Indexed: 11/26/2022]
Abstract
AIMS Our objective was to characterize urinary cytokine/chemokine excretion in adolescents with type 1 diabetes (T1D) and celiac disease (CD) adhering to gluten free diet (GFD) compared to matched T1D patients and healthy control (HC) group from an existing cohort. METHODS Eighteen T1D+CD+GFD patients aged 10-16years were identified and matched 2:1 for age, sex, diabetes duration and glycated hemoglobin to 36 T1D subjects and 36 HC. T1D+CD+GFD patients were adherent with a GFD. Urine and serum levels of cytokines/chemokines as well as baseline clinical and laboratory variables were assessed. RESULTS T1D+CD+GFD patients exhibited lower levels of urinary IL-1B, IL-4, IL-5 (p<0.05) and IFN-γ, IL-8 and G-CSF levels (p<0.07) compared with T1D patients. Urinary biomarker levels between T1D+CD+GFD and HC were mostly similar. In contrast, urinary FGF-2, Flt-3, IL-1B, IL-1RA, IL-4, IL-5, IL-9, IL-10, IL-12p40, IL-15, MIP-1β, and TNF-β (p<0.05) were higher in T1D patients compared to HC. Similar levels of inflammatory markers were seen in the serum for all 3 groups. CONCLUSIONS T1D+CD+GFD patients demonstrated decreased urinary inflammatory cytokine/chemokines compared to T1D and some similar to HC, which is suggestive of a potential modulatory role of treated CD on urinary markers.
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Affiliation(s)
- Emilia N De Melo
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Livia Deda
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Ronnie Har
- Division of Nephrology, Toronto General Hospital, University of Health Network, University of Toronto, 585 University Avenue, Toronto, ON, Canada
| | - Heather N Reich
- Division of Nephrology, Toronto General Hospital, University of Health Network, University of Toronto, 585 University Avenue, Toronto, ON, Canada
| | - James W Scholey
- Division of Nephrology, Toronto General Hospital, University of Health Network, University of Toronto, 585 University Avenue, Toronto, ON, Canada
| | - Denis Daneman
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, Canada
| | - Laura Motran
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Yesmino Elia
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - David Z I Cherney
- Division of Nephrology, Toronto General Hospital, University of Health Network, University of Toronto, 585 University Avenue, Toronto, ON, Canada
| | - Etienne B Sochett
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Farid H Mahmud
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
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Bakker SF, Tushuizen ME, von Blomberg BME, Bontkes HJ, Mulder CJ, Simsek S. Screening for coeliac disease in adult patients with type 1 diabetes mellitus: myths, facts and controversy. Diabetol Metab Syndr 2016; 8:51. [PMID: 27478507 PMCID: PMC4966870 DOI: 10.1186/s13098-016-0166-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/10/2016] [Indexed: 12/23/2022] Open
Abstract
This review aims at summarizing the present knowledge on the clinical consequences of concomitant coeliac disease (CD) in adult patients with type 1 diabetes mellitus (T1DM). The cause of the increased prevalence of CD in T1DM patients is a combination of genetic and environmental factors. Current screening guidelines for CD in adult T1DM patients are not uniform. Based on the current evidence of effects of CD on bone mineral density, diabetic complications, quality of life, morbidity and mortality in patients with T1DM, we advise periodic screening for CD in adult T1DM patients to prevent delay in CD diagnosis and subsequent CD and/or T1DM related complications.
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Affiliation(s)
- Sjoerd F. Bakker
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maarten E. Tushuizen
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Hetty J. Bontkes
- Department of Pathology, Unit Medical Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Chris J. Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, North West Clinics, Alkmaar, The Netherlands
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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Kurien M, Mollazadegan K, Sanders DS, Ludvigsson JF. A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes. Acta Diabetol 2015; 52:1167-74. [PMID: 26403595 DOI: 10.1007/s00592-015-0808-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023]
Abstract
AIMS Celiac disease (CD) may influence metabolic control in type 1 diabetes (T1D). This work examines whether CD in T1D influences hospital admissions due to coma, ketoacidosis and hypoglycemia. METHODS In population-based cohort study, individuals with CD were identified using biopsy data (1969-2008) from Sweden's 28 pathology departments. T1D was defined as a recorded diagnosis of T1D at age ≤30 years in the Swedish National Patient Register between 1964 and 2009. In total, 906 individuals had both T1D and CD and were matched for sex, age and calendar period with 4303 reference individuals. Through stratified Cox regression analysis, we modeled CD as a time-dependent covariate and estimated the risk of future coma, ketoacidosis and hypoglycemia, defined by relevant international classification of disease codes among T1D patients with and without CD. RESULTS During follow-up, patients with both T1D and CD had 49 hospital admissions with diabetic coma, 91 episodes of ketoacidosis and 25 hypoglycemic events. Among patients with T1D, CD did not influence the risk of coma (adjusted HR 0.97; 95 % CI 0.72-1.32), ketoacidosis (adjusted HR 1.08; 95 % CI 0.86-1.34), or hypoglycemia (adjusted HR 1.34; 95 % CI 0.87-2.05). The absolute risk of coma was 621/100,000 person-years in T1D and CD (637 in controls). Corresponding figures for ketoacidosis were 1175/100,000 person-years in T1D and CD (1092 in controls) and for hypoglycemia 316/100,000 person-years (236 in controls). HRs for metabolic emergencies in T1D were similar in the first 5 years after T1D diagnosis as thereafter. CONCLUSIONS Having a diagnosis of CD is unlikely to influence the risk of coma, ketoacidosis and hypoglycemia in T1D patients.
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Affiliation(s)
- Matthew Kurien
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
- Academic Unit of Gastroenterology, University of Sheffield, Sheffield, S10 2RX, UK.
| | - Kaziwe Mollazadegan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
- Academic Unit of Gastroenterology, University of Sheffield, Sheffield, S10 2RX, UK
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden.
- Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.
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Type 1 diabetic adults should be screened for coeliac autoimmunity. Arab J Gastroenterol 2015; 16:81-2. [PMID: 26526509 DOI: 10.1016/j.ajg.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 05/28/2015] [Accepted: 09/26/2015] [Indexed: 11/20/2022]
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Abstract
OBJECTIVES The aim of the study was to evaluate complication screening and follow-up patterns in a population with type 1 diabetes mellitus and celiac disease (T1D/CD) in relation to a matched cohort with celiac disease (CD) alone at our center. METHODS We retrospectively reviewed the health charts of 41 children with T1D and biopsy-proven CD and compared anthropometrics and complication of screening within 2 years from CD diagnosis. Follow-up patterns were determined 3 years postdiagnosis. This population was then compared with a population with both symptomatic and asymptomatic CD matched for age and sex. RESULTS In comparison with T1D/CD, patients with CD alone had a significantly lower height, weight and body mass index (BMI z score 0.01 vs 0.81, P = 0.001) and higher rates of screening for anemia (95% vs 71%, P = 0.003) and bone health (49% vs 29%, P = 0.05). Minimal rates of laboratory abnormalities were observed in either group, irrespective of symptoms at presentation, but CD alone more often presented with anemia than T1D/CD. Repeat serology testing was significantly more frequently performed in the T1D/CD group. Follow-up was equally variable with a median of 3 (range 0-4) visits with a gastroenterologist during the first 3 years postdiagnosis. CONCLUSIONS These results suggest that patients with T1D/CD represent a distinct and possibly milder phenotype from CD alone. Complication screening was variable and negative for the majority of the patients. Guidelines for follow-up may need to be tailored to specific groups to standardize evaluation and complication screening, especially with regard to bone health.
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DeMelo EN, McDonald C, Saibil F, Marcon MA, Mahmud FH. Celiac Disease and Type 1 Diabetes in Adults: Is This a High-Risk Group for Screening? Can J Diabetes 2015; 39:513-9. [PMID: 26293006 DOI: 10.1016/j.jcjd.2015.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 12/27/2022]
Abstract
The association between celiac disease (CD), an autoimmune condition involving intestinal inflammation related to gluten ingestion, and type 1 diabetes has long been recognized. CD prevalence rates 4 to 6 times greater in adults with type 1 diabetes than in the general population. Much of the existing literature focuses on important implications related to the impact of a gluten-free diet on short-term outcomes in metabolic control and quality of life. Canadian Diabetes Association guidelines recommend targeted CD screening in patients with type 1 diabetes who have classic symptoms, such as abdominal pain, bloating, diarrhea, unexplained weight loss or labile metabolic control; however, a significant proportion (40% to 60%) of patients may have mild or absent symptoms. Recent evidence suggests that adult patients with both conditions are at higher risk for diabetes microvascular comorbidities, increased mortality and impaired bone health if the CD is untreated. The purpose of this review is to describe the association between CD and type 1 diabetes and to summarize recent literature that evaluates risks in patients with both conditions.
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Affiliation(s)
- Emilia N DeMelo
- Division of Endocrinology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte McDonald
- Department of Medicine, Division of Endocrinology and Metabolism, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig ME. Screening for Celiac Disease in Type 1 Diabetes: A Systematic Review. Pediatrics 2015; 136:e170-6. [PMID: 26077482 DOI: 10.1542/peds.2014-2883] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Prevalence rates of type 1 diabetes (T1D) and celiac disease (CD) vary from 1.6% to 16.4% worldwide. Screening guidelines are variable and not evidence based. Our aim was to conduct a systematic review of CD in T1D. METHODS Medline, Embase, and the Cochrane Library were searched. Studies were limited to those in English and in humans. We selected longitudinal cohort studies screening for CD in T1D with at least 5 years of follow-up. Screening rates, characteristics, and prevalence of biopsy-proven CD in people with T1D were extracted. RESULTS We identified 457 nonduplicate citations; 48 were selected for full-text review. Nine longitudinal cohort studies in 11,157 children and adolescents with 587 cases of biopsy-proven CD met the inclusion criteria. Median follow-up was 10 years (range: 5-18 years). The weighted pooled prevalence of CD was 5.1% (95% confidence interval: 3.1-7.4%). After excluding 41 cases with CD onset before T1D, CD was diagnosed in 218 of 546 (40%) subjects within 1 year, in 55% within 2 years, and in 79% within 5 years of diabetes duration. Two studies (478 cases) reported higher rates of CD in children aged <5 years at T1D diagnosis. The duration of follow-up varied across the included studies. CD screening frequency progressively decreased with increased T1D duration. CONCLUSIONS Because most cases of CD are diagnosed within 5 years of T1D diagnosis, screening should be considered at T1D diagnosis and within 2 and 5 years thereafter. CD screening should be considered at other times in patients with symptoms suggestive of CD. More research is required to determine the screening frequency beyond 5 years of diabetes duration.
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Affiliation(s)
- Anna Pham-Short
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Geoffrey Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | | | - Stephen Twigg
- Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital and Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia; and
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, Australia
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Akirov A, Pinhas-Hamiel O. Co-occurrence of type 1 diabetes mellitus and celiac disease. World J Diabetes 2015; 6:707-14. [PMID: 26069719 PMCID: PMC4458499 DOI: 10.4239/wjd.v6.i5.707] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/30/2014] [Accepted: 03/16/2015] [Indexed: 02/05/2023] Open
Abstract
The co-occurrence of celiac disease (CD) and type 1 diabetes (T1DM) has been reported as 5-7 times more prevalent than CD alone. The clinical presentation and natural history of CD in patients with T1DM may vary considerably. Less than 10% of patients with T1DM and CD show gastrointestinal symptoms. Therefore, experts support screening for CD in T1DM patients, though there is no consensus as to the recommended frequency of screening. When stratified by time since CD diagnosis, longer follow-up and coexistence of CD are associated with significant increased risk of diabetic associated morbidity and mortality. Early CD diagnosis and treatment with a gluten-free diet are essential.
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Affiliation(s)
- Kaziwe Mollazadegan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden
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Mahmud FH, De Melo EN, Noordin K, Assor E, Sahota K, Davies-Shaw J, Cutz E, Somers G, Lawson M, Mack DR, Gallego P, McDonald C, Beaton MD, Bax K, Saibil F, Gilbert J, Kirsch S, Perkins BA, Cino M, Szentgyorgyi E, Koltin D, Parikh A, Mukerji G, Advani A, Lou O, Marcon MA. The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) protocol: a randomised controlled study to evaluate treatment of asymptomatic coeliac disease in type 1 diabetes. BMJ Open 2015; 5:e008097. [PMID: 25968008 PMCID: PMC4431067 DOI: 10.1136/bmjopen-2015-008097] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Coeliac disease (CD) is an autoimmune condition characterised by gluten-induced intestinal inflammation, and observed at a 5-10 fold greater prevalence in type 1 diabetes. While universal screening for CD in patients with diabetes is frequently advocated, objective data is limited as to benefits on diabetes control, bone health or quality of life related to the adoption of a gluten-free diet (GFD) in the large proportion of patients with diabetes with asymptomatic CD. The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) study is a multicenter, randomised controlled trial to evaluate the efficacy and safety of a GFD in patients with type 1 diabetes with asymptomatic CD. METHODS AND ANALYSIS Children and adults (8-45 years) with type 1 diabetes will be screened for asymptomatic CD. Eligible patients with biopsy-proven CD will be randomly assigned in a 1:1 ratio to treatment with a GFD for 1 year, or continue with a gluten-containing diet. The primary outcome will evaluate the impact of the GFD on change in glycated haemoglobin. Secondary outcomes will evaluate changes in bone mineral density, blood glucose variability and health-related quality of life between GFD-treated and the regular diet group over a 1-year period. The study was initiated in 2012 and has subsequently expanded to multiple paediatric and adult centres in Ontario, Canada. ETHICS AND DISSEMINATION The findings from this study will provide high-quality evidence as to the impact of GFD treatment on glycaemic control and complications in asymptomatic children and adults with CD and type 1 diabetes. TRIAL REGISTRATION NUMBER NCT01566110.
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Affiliation(s)
- Farid H Mahmud
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emilia N De Melo
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karima Noordin
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Esther Assor
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kamaljeet Sahota
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Davies-Shaw
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ernest Cutz
- Department of Pathology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gino Somers
- Department of Pathology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Lawson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Patricia Gallego
- Division of Endocrinology Paediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Charlotte McDonald
- Division of Endocrinology and Metabolism, St. Joseph Health Care, London Health Sciences Centre, London, Ontario, Canada
| | - Melanie D Beaton
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Kevin Bax
- Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeremy Gilbert
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan Kirsch
- Division of Endocrinology, Markham Stouffville Hospital, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maria Cino
- Division of Gastroenterology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eva Szentgyorgyi
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dror Koltin
- Division of Endocrinology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Amish Parikh
- Division of Endocrinology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Geetha Mukerji
- Division of Endocrinology, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrew Advani
- Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Olivia Lou
- Juvenile Diabetes Research Foundation—Canadian Clinical Trials Network (JDRF-CCTN), Toronto, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Kelly CP, Bai JC, Liu E, Leffler DA. Advances in diagnosis and management of celiac disease. Gastroenterology 2015; 148:1175-86. [PMID: 25662623 PMCID: PMC4409570 DOI: 10.1053/j.gastro.2015.01.044] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/04/2015] [Accepted: 01/25/2015] [Indexed: 12/25/2022]
Abstract
Celiac disease is an autoimmune disorder that is induced by dietary gluten in genetically predisposed individuals. It has a prevalence of approximately 1% in many populations worldwide. New diagnoses have increased substantially, owing to increased awareness, better diagnostic tools, and probable real increases in incidence. The breadth of recognized clinical presentations continues to expand, making the disorder highly relevant to all physicians. Newer diagnostic tools, including serologic tests for antibodies against tissue transglutaminase and deamidated gliadin peptide, greatly facilitate diagnosis. Tests for celiac-permissive HLA-DQ2 and HLA-DQ8 molecules are useful in defined clinical situations. Celiac disease is diagnosed by histopathologic examination of duodenal biopsy specimens. However, according to recent controversial guidelines, a diagnosis can be made without a biopsy in certain circumstances, especially in children. Symptoms, mortality, and risk for malignancy each can be reduced by adherence to a gluten-free diet. This treatment is a challenge, however, because the diet is expensive, socially isolating, and not always effective in controlling symptoms or intestinal damage. Hence, there is increasing interest in developing nondietary therapies.
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Affiliation(s)
- Ciarán P. Kelly
- Celiac Program, Harvard Medical School & Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gastroenterology, Dana 601E, Boston, MA 02215-5400, United States, Phone: (617) 667-1272
| | - Julio C. Bai
- Hospital Gastroenterologia, Dr. Bonorino Udaondo, Av. Casero 2061, Buenos Aires, 1264, Argentina, Phone: +549114404-8022
| | - Edwin Liu
- Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado and the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045. United States, Phone: (720) 777-6669
| | - Daniel A. Leffler
- Celiac Program, Harvard Medical School & Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gastroenterology, Dana 501, Boston, MA 02215-5400, United States, Phone: (617) 667-1272
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