Celiac disease triples risk of diabetes

NEW YORK, Nov 11 (Reuters) Children with celiac disease have a higher likelihood of a subsequent diagnosis of type one (insulin-dependent) diabetes -- approximately three-fold higher -- than the general population, according to results of a population-based cohort study in Sweden.

Celiac disease is caused by allergy to gluten, found mainly in wheat. It can cause intestinal cramping, pain, bloating, diarrhea, and weight loss.

''We believe that celiac disease predisposes children to type 1 diabetes,'' lead author Dr Jonas F Ludvigsson told Reuters Health. ''Some children receive a type one diabetes diagnosis prior to identification of celiac disease, suggesting that the celiac disease has been asymptomatic and ongoing for several years.'' In a second study, also published in Diabetes Care this month, Danish researchers established that celiac disease is common in children with type one diabetes. In contrast, there has been little focus on patients in whom celiac disease is diagnosed prior to a diagnosis of type one diabetes.

In their study, Dr Ludvigsson of the Orebro University Hospital and colleagues used the Swedish National inpatient register for the period between 1964 and 2003 to identify 9243 individuals with celiac disease diagnosed before age 20 years.

They matched these patients to five reference subjects without celiac disease.

Children with celiac disease had a significantly higher risk of being diagnosed with type one diabetes before their 20th birthday. The hazard ratio for diabetes in children with celiac disease was 2.4.

The risk was further elevated when Ludvigsson's group included patients diagnosed with diabetes at any time following the first symptoms of celiac disease, and when they only included children diagnosed with diabetes one to five years after their first diagnosis of celiac disease.

The researchers posit that the association of celiac disease with subsequent type one diabetes could be due to autoantibodies expressed after early exposure to gluten in their diet. Other explanations include a common genetic susceptibility.

The Swedish investigators found no strong evidence that an earlier introduction of a gluten-free diet in patients with celiac disease protects against type one diabetes.

''Most children being investigated for celiac disease have already had their glucose tested,'' Ludvigsson noted. ''If blood tests or urinalysis have not been undertaken at diagnosis of celiac disease, I recommend that they be checked.'' He continued, ''In the absence of increased blood glucose levels or lack of urinary glucose, I do not recommend further testing for type one diabetes. However, I inform patients with newly diagnosed celiac disease about typical symptoms of type 1 diabetes and urge them to contact their doctor in case they suspect type one diabetes. Such symptoms may include increased thirst, increased urination, weight loss and fatigue.'' REUTERS BDP HS0924