Diabetes

17 October 2017

Type 1 diabetes linked to coeliac disease

A new study suggests that young children with type 1 diabetes also need to be screened for coeliac disease, as these two go hand in hand.

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Type 1 diabetes is an autoimmune disease that causes the body's immune system to mistakenly attack the insulin-producing cells in the pancreas, according to the American Diabetes Association.

Parents of young children with type 1 diabetes need to be on the lookout for symptoms of another autoimmune condition – coeliac disease, new research suggests.

The study found these youngsters appear to face a nearly tripled risk of developing coeliac disease autoantibodies, which eventually can lead to the disorder, which is chronic and causes an intolerance to gluten, which damages the small intestinal lining. The severity of symptoms differs from person to person.

Genetically related

"Type 1 diabetes and coeliac disease are closely related genetically," explained study author Dr William Hagopian.

"People with one disease tend to get the other. People who have type 1 diabetes autoantibodies should get screened for coeliac autoantibodies," Hagopian said. He directs the diabetes programme at the Pacific Northwest Research Institute in Seattle.

Insulin is a hormone that helps to usher the sugar from foods into the body's cells to be used as fuel. Because the autoimmune attack leaves people with type 1 diabetes without enough insulin, they must replace the lost insulin through injections or an insulin pump with a temporary tube inserted under the skin.

Coeliac disease is an autoimmune disease that causes the immune system to attack the lining of the small intestine when gluten is consumed, according to the Coeliac Disease Foundation. Gluten is a protein found in wheat. Symptoms of coeliac disease include stomach pain and bloating, diarrhea, vomiting, constipation, weight loss, fatigue and delayed growth and puberty.

Early diagnosis important

Dr James Grendell is chief of the division of gastroenterology at NYU Winthrop Hospital in Mineola, New York. He explained why knowing ahead of time that coeliac may be developing can be helpful.

"Early diagnosis of coeliac disease is important to initiate treatment with a gluten-free diet to prevent complications, particularly growth retardation in children," he said.

"Other significant complications include iron-deficiency anemia, osteoporosis and a form of skin rash. Less common, but potentially lethal, complications include lymphoma and carcinoma of the small intestine," Grendell added.

Treatment for the disease involves not ingesting anything containing gluten.

According to Hagopian, "Coeliac is about three times more common in the general population than type 1 diabetes."

Previous research has pegged the co-occurrence of type 1 diabetes and coeliac disease at around 5% to 8%, the study authors said.

What the research entailed 

To get a better idea of when these diseases start to occur together, as well as what might trigger them, the researchers looked at data from a prospective study of children with a high genetic risk of developing type 1 diabetes. The primary aim of the study was to find environmental causes of type 1 diabetes.

The research included almost 6 000 youngsters from six US and European medical centers. The participants all had the necessary autoantibody testing. The median follow-up time was 66 months (5.5 years), the study said.

Autoantibodies linked to type 1 diabetes were found in 367 children, according to the report. Autoantibodies linked to coeliac disease were found in 808 youngsters. Autoantibodies associated with both conditions were found in 90 children.

Autoantibodies for type 1 diabetes typically appeared before those for coeliac disease, the study authors noted.

Association but not causation

That doesn't necessarily mean that type 1 diabetes caused the development of coeliac autoantibodies, said Dr Christine Ferrara, an adjunct assistant professor at the University of California, San Francisco. She co-authored an editorial that accompanied the study.

"The results of this paper demonstrate an association, but do not establish causation," Ferrara said.

The findings were published online in the journal Pediatrics.

Hagopian said it's possible that type 1 diabetes may somehow trigger coeliac disease. But it could also be an overlapping environmental factor that starts the disease process in both cases, he added.

Immune system needs to be regulated

Ferrara explained that "people need to recognise that regulation of the immune system underlies multiple disease processes."

Hagopian said it's important to note that the study only looked at children under six.

Grendell agreed with Hagopian that a diagnosis of type 1 should signal the need to look for coeliac disease.

"The take-home message for the public is that type 1 diabetes mellitus appears to be a risk factor for the development of coeliac disease and, as already recommended, patients [usually children] diagnosed with type 1 diabetes mellitus should be screened for this highly treatable disease," he said.

Image credit: iStock

 

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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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