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  • Oral presentation
  • Open Access

Do patients with celiac disease patients differ from those with concurrent celiac disease with type 1 diabetes mellitus?

  • 1,
  • 2 and
  • 3
International Journal of Pediatric Endocrinology20132013 (Suppl 1) :O30

https://doi.org/10.1186/1687-9856-2013-S1-O30

  • Published:

Keywords

  • Diarrhea
  • Constipation
  • Celiac Disease
  • Gluten Free Diet
  • Celiac Disease Patient

Background and objectives

Celiac disease (CD) and type 1 diabetes mellitus (T1DM) share common genetic loci. Patients with T1DM developing CD may remain asymptomatic and some of the common symptoms of CD may be considered as part of the chronic complications of diabetes like gastrointestinal intolerance, diarrhea, nocturnal diarrhea, alternate diarrhea and constipation.

There are no reports on comparison of presenting features of patients with CD and those with CD and T1DM together. The present study was planned to compare clinical, biochemical and hormonal profile of patients of CD and CD with T1DM.

Patients and methods

Consecutive CD patients with and without T1DM ≤ 20 years seen by us were evaluated clinically and underwent thyroid, gonadal function tests (where applicable) and serum cortisol, besides routine hemogram and biochemical tests. Patients were subjected to screening for CD by anti tissue transglutaminase antibodies (tTGAb) and those positive were subjected to endoscopy of descending part of the duodenum, and 3 biopsies were taken. Histological interpretation was done by an experienced pathologist and recorded as per modified Marsh classification [1]. Patients were diagnosed to have CD as per modified ESPGHAN criteria [2] and T1DM as per ADA position statement [3]. All patients received gluten free diet (GFD) and / or diabetic diet. Patients with CD alone (group A) were compared with those having CD with T1DM (Group B).

Results

109 patients (57 males) with mean age of 14.9±2.9 year fulfilled the eligibility criteria. 23 (21.1%) had T1DM and CD while CD alone was present in 86 subjects. The age at diagnosis of CD was younger (11.5±4.6 vs 13.8 ±3.4 yr; p<0.05) and the lag period between symptoms and diagnosis of CD was shorter (20.2 ± 31.8 vs 56.1 ± 42.4 months; p<0.05) in those with Group B. Detailed clinical features of patients in two groups are given in Table 1 and laboratory parameters are enumerated in Table 2. Comparing the clinical features in between groups, short stature (87% versus 40.9%, p < 0.0001), anemia (80.9% versus 45%, p<0.001) and delayed puberty (61.9% versus 29.4%, p<0.014) were significantly more common in the Group A. However, diarrhea, constipation and weight loss were comparable in both the groups.
Table 1

Symptoms in patients with celiac disease alone and celiac disease with type 1 diabetes mellitus

S.No

Clinical Features

All Patients (N= 109)

CD Alone (Group A, N=86)

CD+T1DM (Group B, N=23)

P value (Group A&B))

1.

Short stature

77.1%

87%

40.9%

.000

2.

Diarrhoea

56.9%

40.7%

50%

.431

3.

Constipation

4.6%

3.5%

9.5%

.246

4.

Anemia

70.6%

80.9%

45%

.001

5.

Delayed Puberty

52.3%

61.9%

29.4%

.014

6.

Weight loss

55%

61.9%

45%

.168

7.

Hypothyroidism

8.2%

8.1%

5%

.788

8.

Rickets

3.7%

3.5%

4.3%

.096

9.

Goitre

19.3%

20.9%

13%

.704

10.

Hypoadrenalism

0.9%

1.2%

0%

.246

Table 2

Laboratory parameters of patients with celiac disease alone and celiac disease with type 1 diabetes mellitus.

S.No

Biochemical Parameters

All Patients (N= 109)

CD Alone (Group A, N=86)

CD+T1DM (Group B, N=23)

P value (Group A&B))

1.

Serum IgA tTG (mIU/L)

123.2±110.9

118.3±112.9

139.5±111.1

.433

2.

Hemoglobin (gm/dl)

8.6±2.6

8.3±2.4

10.1±3.2

.018

3.

T3

1.3±0.43

1.3±0.4

1.4±0.6

 

4.

T4

8.1±2.6

8.1±2.7

7.7±3.1

 

5.

TSH(mIU/L)

9.7±34.5

7.1±21.7

22.4±69.5

.146

6.

LH(mIU/L)

2.5±2.6

2.6±2.8

1.9±1.8

.596

7.

Calcium (mg/dl)

9.35±1.87

8.9±0.9

9.4±1.9

 

8.

Phosphate (mg/dl)

4.7±1.0

4.7±1.0

4.4±0.83

 

9.

ALP(IU/L)

118.0±108.4

110.2±106.4

116.6±129.5

 

10.

Albumin (gm/dl)

4.0±0.6

4.05±0.7

4.3±0.5

 

11.

SGOT

39.2±26.5

32.8±16.8

39.7±42.1

 

12.

SGPT

36.3±31.2

28.6±15.6

34.2±58.0

 

Conclusions

Present study suggests that patients with celiac disease alone are more symptomatic and associated with more biochemical abnormalities compared to those with celiac disease and T1DM. It will be worthwhile to plan a prospective study with long duration of follow up and more number of patients in both groups to further validate the results.

Authors’ Affiliations

(1)
Senior Resident, Deptt. Of Endocrinology, PGIMER, Chandigarh, India
(2)
Associate Professor, Deptt. Of Endocrinology, PGIMER, Chandigarh, India
(3)
Professor, Deptt. Of Gastroenterology, PGIMER, Chandigarh, India

References

  1. Marsh MN, Crowe PT: Morphology of the mucosal lesion in gluten sensitivity. Ballieres Clin Gastroenterol. 1995, 9: 273-293. 10.1016/0950-3528(95)90032-2.View ArticleGoogle Scholar
  2. Walker-Smith JA, Sandhu BK, Isolauri E, et al: Revised criteria for the diagnosis of celiac disease, report of the working group of the European Society of Pediatric Gastroenterology. Arch Dis Child. 1990, 65: 909-11.View ArticleGoogle Scholar
  3. Standards of Medical Care in Diabetes—2011. Diabetes Care. 2011, 34: S11-S61.Google Scholar

Copyright

© Rastogi et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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