Doctors & PatientCeliac disease and Type 1 diabetes are both autoimmune disorders, so I suppose it’s not terribly shocking that there would be a large overlap between the two populations. However, the study recently published in the Italian Journal of Pediatrics is fascinating for the insights it has found about those who have both celiac disease and diabetes.

The study did not examine new patients, but rather combed through existing studies to pool as much data as possible. They found a number of interesting statistics, with implications for diagnosing and treating both medical conditions. More specifically, the researchers found that within the data they surveyed:

  • Although the general population has a rate of celiac disease of only 0.5 percent, the rate for people with Type 1 Diabetes (hereafter T1D) is beween 4.4 and 11.1 percent. Both conditions share a common genetic heritage.
  • Patients who have both diseases tend to develop diabetes at a younger age than those who “only” have diabetes. Although diabetes is often diagnosed first and celiac disease second (because of screenings at the time of T1D diagnosis), some medical professionals speculate that silent or mildly symptomatic celiac disease may be triggering diabetes and/or other thyroid disorders. Doctors do not know if an early adaptation of a gluten-free diet could help to prevent diabetes or other thyroid disorders from being activated in susceptible patients.
  • Although celiac disease is far, far, far more common amongst people with T1D, these celiac patients often present with so-called atypical symptoms. Fewer than ten percent of children with Type 1 Diabetes and celiac disease have so-called gastrointestinal presentation, eg malnutrition, diarrhea, constipation, vomiting, abdominal pain, etc.
  • Compliance to the gluten-free diet amongst this overlapping population tends to be good when classic celiac symptoms appear and poor when the celiac disease is silent or low-symptom. Given that many people with both conditions have atypical presentation of celiac disease, this is quite concerning. Data from the study indicates that in Australia compliance with the gluten-free diet may be as low as 25-30%, and in Italy it may be as low as 59%.
  • Even in patients who are symptom-free (but diagnosed with both celiac and T1D), positive changes in bone miniral density and weight gain (for malnourished children, presumably) have been found.
  • Even in patients who are testing negative for celiac antibodies, inflammation has been found in the intestines. It remains unclear whether this inflammation is gluten-related.
  • Many gluten-free alternatives to traditional gluten-containing foods (like sandwich bread) are actually higher on the glycemic index than their gluten-containing alternatives. Given the importance of avoiding blood sugar spikes for the diabetic population, this puts patients with both conditions (or their parents) in a difficult position.
  • Quality of life is generally better for those patients who are compliant with a gluten-free diet (if indeed they have both celiac disease and T1D) however many patients — especially teenagers — are not compliant.

For more information, you can check out the study on PubMed or the overview on Does anyone in your life have both celiac disease and Type 1 diabetes? If so does the data in this study ring true?