Celiac Disease & Diabetes: Who’s Most at Risk?

August 19, 2016
Veronica Hackethal, MD

A large study of celiac disease looked at prevalence of T1DM and T2DM, and health risks associated with having both celiac disease and diabetes.

Men with T1DM may be particularly at risk for celiac disease, and having either T1DM or T2DM along with celiac disease may increase the risk for other serious health problems, according to results from a Finnish study published online in BMC Gastroenterology.

“A novel finding of the present study is that DM1 is markedly overrepresented especially in men with celiac disease, whereas the prevalence of DM2 was practically similar to that of the Finnish population in general. Furthermore, concomitant DM1 or DM2 predispose celiac disease patients to severe comorbidities, and DM1 also to lower adherence to the gluten-free diet,” wrote lead author Kalle Kurppa, MD, PhD, of the University of Tampere, Finland, and colleagues.

Current estimates suggest that the prevalence of celiac disease ranges between 1-2% in Westernized countries, making it one of the most common food-related disorders in the regions. Past studies have shown that celiac disease is more common in T1DM, and that both share a genetic predisposition. However, the majority of studies have been done in children. The effect of T1DM on clinical and biopsy findings in adult celiac patients has remained unclear.

In the study, researchers compared the prevalence of T1DM and T2DM in 1358 patients with biopsy-confirmed celiac disease to data on the general Finnish population aged 30 and over drawn from the Health 2000 survey, a nationally representative study. They also compared clinical and histological features, as well as adherence to a gluten free (GF) diet in patients with celiac disease alone and those with celiac disease plus T1DM or T2DM. Information on demographics, clinical and histological data, blood hemoglobin, celiac disease serology, concomitant medical conditions, family history of celiac disease, and adherence to a GF diet came from medical records and personal interview. Diagnosis of T1DM or T2DM was made according to national guidelines. Nonadherence to a GF diet was defined as more than one lapse per month, and confirmed by measuring endomysial antibodies after one year on a GF diet.

 Key results:

• T1DM prevalence was roughly five times more common in those with celiac disease vs the general population, with even higher prevalence in men:

♦ Celiac patients: 1.8% in women, 8.0% in men

♦ General population: 0.3% in women, 0.7% in men

• T2DM prevalence was about the same in celiac disease vs the general population:

♦ Celiac patients: 2.5% in women, 4.3% in men

♦ General population: 3.0% women, 4.4% men

• Compared to those with celiac disease only and celiac disease plus T2DM, having celiac disease plus T1DM was associated with:

♦ Less other gastrointestinal diseases (P=0.028),

♦ More thyroid diseases (P=0.043)

♦ Lower dietary adherence (P<0.001)

♦ Higher endomysial antibodies on a GF diet (P<0.001)

• Those with T2DM and celiac disease had more hypercholesterolemia (P=0.024)

• Those with either T2DM or T1DM and celiac disease had more hypertension (P<0.001) and coronary artery disease (P<0.001) than those with celiac disease only

• No significant differences in prevalence of osteoporosis, asthma, or cancer between the three groups

• Repeat biopsy after one year on a GF diet showed a trend toward slower histological recovery in those with T2DM compared to T1DM and the general population (44%, 65%, 71% , respectively, P=0.059), BUT:

♦ There was significantly more subtotal/total villous atrophy in those with T1DM vs T2DM and the general population (12%, 6%, 5%, respectively, P=0.059)

The findings provide confirmation of past studies in the US showing increased risk for T1DM in those with celiac disease. They also provide confirmation for past studies suggesting that T2DM is not increased in celiac disease and may even be less common compared with T1DM and the general population. 

The authors emphasized that adhering to the GF diet might prove particularly challenging for those with T1DM and celiac disease who are faced with daily glucose monitoring, carbohydrate counting, and insulin dosing. They also noted that further research is needed to explore why having T2DM may predispose to slower mucosal recovery following adherence to the GF diet, and why having T1DM may result in poorer histological recovery.   

They concluded: “Clinicians should be aware that that the double diagnosis of celiac disease and either DM2 or DM1 predisposes the patients to severe co-morbidities. Celiac disease patients with concomitant DM1 have increased risk for dietary lapses and possibly also to poorer histological recovery, and require therefore specifically-tailored support and careful follow-up.”

Take-home Points

• Finnish study found T1DM prevalence was roughly five times more common in those with celiac disease vs the general population, with men particularly at risk.

• T2DM prevalence was about the same in celiac disease vs the general population.

• Having celiac disease plus T1DM was associated with lower adherence to the GF diet and higher endomysial antibody titers after one year on a GF diet.

• Having either T2DM or T1DM and celiac disease was associated with significantly more hypertension and coronary artery disease than having celiac disease only.

• There was a trend toward slower histological recovery after one year on the GF diet in those with T2DM; those with T1DM had poorer histological recovery.

The authors declare no conflicts of interest.

Reference: Kylökäs A, et al. Type 1 and type 2 diabetes in celiac disease: prevalence and effect on clinical and histological presentation. BMC Gastroenterol. 2016 Jul 25;16(1):76.

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