Type 1 Diabetes and Celiac Disease: Overview and Medical Nutrition Therapy
- Sarah Jane Schwarzenberg, MD and
- Carol Brunzell, RD, CDE
In patients with celiac disease (gluten-sensitive enteropathy, or GSE), ingestion of the gliadin fraction of wheat gluten and similar molecules (prolamins) from barley, rye, and possibly oats causes damage to the intestinal epithelium. The injury results from an abnormal T-cell response against gliadin. Thus, GSE is a disease in which host susceptibility must be combined with a specific environmental trigger to affect injury.1
Typically, patients with GSE have chronic diarrhea and failure to thrive. However, some patients present with short stature, flatulence, or recurrent abdominal pain. Dermatitis herpetiformis, a pruritic papular rash, is directly related to GSE.2 Other atypical presentations are increasingly recognized, among them iron-deficiency anemia, osteopenia/osteoporosis, short stature, dental enamel hypoplasia, arthritis and arthralgia, chronic hepatitis/hypertransaminasemia, and neurological problems. GSE has also been found in asymptomatic individuals who nonetheless have evidence of intestinal mucosal injury on biopsy.1
Celiac Disease and Type 1 Diabetes
An association of diabetes with GSE has been observed since the late 1960s. In recent years, it has become clear that the incidence of GSE in patients with type 1 diabetes is substantial. A prevalence rate of 4–6% in type 1 diabetes has been reported.3–5 Some of the variation in prevalence can be attributed to the different diagnostic criteria used in the studies.
The majority of patients with GSE are asymptomatic4 or are not aware of symptoms. Some patients present with problems recognized only retrospectively as resulting from celiac disease; it is common for “asymptomatic” patients to report improved health or sense of well-being when following a gluten-free diet. Up to one-third of patients may have unexplained failure to thrive, abdominal pain, or short stature.3,6
More controversial is the question of whether GSE affects blood glucose control. A study by Acerini et al.7 in a type 1 diabetic population found …
