Coeliac disease and diabetes
Coeliac disease and
dermatitis herpetiformis is more common in people with certain other autoimmune diseases, such as
Type 1 diabetes mellitus (T1DM). This association is probably due to both diseases having a common genetic predisposition. HLA-DQB1 is present in the majority of patients with both conditions. Autoimmune thyroid disease may also co-exist with both coeliac disease and
Type 1 diabetes. It has been shown that when coeliac disease is diagnosed before diabetes the clinical presentation of diabetes is more severe and there is a higher prevalence of multiple autoimmune diseases. In patients with
coeliac disease and T1DM adherence to a gluten-free diet helps with diabetic control. It has thus been suggested that all patients with T1DM and their first-degree relatives should be screened for coeliac disease. At present there is no specific policy on screening for coeliac disease in adults with T1DM but Scottish guidelines recommend that young people with T1DM should have coeliac serology checked at diagnosis. There is no increased risk of coeliac disease in patients with
Type 2 diabetes mellitus.
How common is Type 1 diabetes in coeliac disease?
In the general population T1DM affects approximately 0.75% of people and
coeliac disease affects 1%. T1DM occurs in about 5% of patients with coeliac disease, and when patients with type 1 diabetes are screened for coeliac disease 6-10% are antibody positive and/or biopsy positive. Coeliac disease should therefore be suspected in any patient who has T1DM with gastrointestinal symptoms or unexplained anaemia.
Presentation and symptoms of coeliac disease in diabetes
The symptoms of coeliac disease are very diverse, ranging from severe to vague or mild symptoms. The diagnosis of coeliac disease can precede that of T1DM, but in most cases (about 90%) diabetes is diagnosed first. Probably because T1DM generally has an acute onset, which is easily identifiable as early symptoms. The varied and atypical presentation of coeliac disease is very often missed or symptoms of ill health are attributed to the already diagnosed
diabetes. Malabsorption commonly occurs in patients with undiagnosed coeliac disease and T1DM. Recurrent
hypoglycaemia has been reported as a presenting sign of
coeliac disease in individuals with T1DM and unstable diabetes and growth failure in
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