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Microvascular Complications Due to Celiac Disease and Type 1 Diabetes

Studies yet to determine if gluten-free diet will decrease risk of retinopathy, nephropathy…

Celiac Disease (CD) and type 1 diabetes are frequently associated with each other, as they have common genetic disorders. Current guidelines recommend screening patients with new onset diabetes for celiac disease and regularly thereafter. New studies have led to questions concerning whether celiac disease is a risk factor for microvascular complications. German researchers recently investigated whether CD associated with type 1 diabetes increases the risk of microvascular complications.

The study involved 56,514 patients greater than ten years of age with diabetes for less than twenty years from 392 centers in Germany and Austria. The patients were placed in one of three categories: no celiac disease (50,933), biopsy-confirmed celiac disease (812), or suspected CD (4,769; clinical diagnosis or positive antibodies). Researchers used Cox proportional hazard regression to adjust for potential confounders (glycated hemoglobin, age at diabetes onset, sex, smoking, dyslipidemia, and hypertension).

Kaplan-Meier analysis showed that 25% of patients without CD had developed retinopathy at age 33.7 years (95% CI 33.2-34.4), a significant difference as compared to the 26.7 years (23.7-30.2) for those with suspected or confirmed CD. Moreover, retinopathy developed in 25% of patients without CD and 25% of patients with suspected or confirmed CD after having diabetes for 23.4 and 18.6 years, respectively. This difference was not found to be significant (P=0.2453). After using a multivariable analysis using Cox proportional hazards modeling, CD remained a statistically significant risk factor even after adjusting for long term median HbA1c, age of onset, sex, blood pressure, lipid status, and smoking.

Celiac disease was found to be an independent risk factor for retinopathy and nephropathy in patients suffering from type 1 diabetes. This finding validates and supports current guidelines for CD testing in diabetes patients. Further research must be done to see if a gluten-free diet will decrease the risk of microvascular disorders in patients suffering from both diabetes and CD.

Practice Pearls:

  • Clinicians should continue to screen type 1 diabetic patients for celiac disease on a regular basis.
  • Regular eye exams and urine albumin tests should be performed for diabetes patients.
  • Although more research must be done, a gluten-free diet could be a good option and potentially benefit patients suffering from diabetes and celiac disease.

Tilman RR. Microvascular Complications in Childhood-Onset Type 1 Diabetes and Celiac Disease: A Multicenter Longitudinal Analysis of 56,514 Patients From the German-Austrian DPV Database. Diabetes Care. May 2015; 38(5)801-07