CELIAC DISEASE IN SUBJECTS WITH TYPE 1 DIABETES MELLITUS AND ITS EFFECT ON GLYCEMIC CONTRO
Abstract
Objective: To observe celiac disease incidence in patients with diabetes mellitus 1 and its effect on glycemic control.
Methods: Type 1 diabetic patients presenting in the Sughra Diabetic clinic in Benazir Bhutto Hospital from 22 August 2011 till 22 February 2012 were included in this study. Medical history, including age of the patient at diagnosis of diabetes, duration of disease and daily insulin requirements was taken. Subjects with positive tTGAb levels had biopsy of 2nd part of duodenum to confirm CD according to Marsh criteria on histopathological examination.
Results: The study included 125 patients with type 1 diabetes mellitus. The mean age was 30.08±8.9 years. 42 (33.6%) were males and 83 (66.4%) females. 5 (4%) of type 1 diabetics had celiac disease. All 5 had both a positive anti-tissue transglutaminase antibodies (>24 U/ml) and all 5 also had histopathological changes confirming celiac disease. 4 had Marsh stage 3 (2 had stage 3b and 2 had stage 3c) and 1 had Marsh stage 4 changes on histopathology. All 5 CD-positive patients (100%) had poorly controlled diabetes whereas among CD-negative patients only 26 (21.6%) had well controlled diabetes; this difference was p = 0.242.
However, mean HbA1c level CD-positive patients was significantly higher than HbA1c of CD-negative patients; p = 0.015. The mean daily insulin requirement of CD-positive patients was significantly lower than CD-negative patients; p = 0.000.
Conclusions: The incidence of celiac disease in type 1 diabetics increases as compared to general population. Because most diabetics are asymptomatic, it is better to screen all. Moreover, CD is associated with lesser daily insulin requirement and poorer diabetes control.
