How to diagnose coeliac disease
Serum anti transglutaminase (TGA) and anti-endomysial antibodies (EMA) are considered to be sensitive diagnostic markers for coeliac disease. However the presence or absence of IgA deficiency has been reported in a group of patients with T1DM and it has therefore been suggested that IgG1 EMA should also be sought whenever a patient with T1DM undergoes screening for coeliac disease. It is possible to have a negative blood test yet still have coeliac disease. Some patients with T1DM may be negative for CD antibodies early in their diagnosis but may later become antibody positive. Some patients with positive antibodies may have negative small-bowel biopsies and may have latent coeliac disease. There is therefore a case for monitoring of the situation: any screening strategy should consider repeat serological testing at intervals.What are the benefits of diagnosis of coeliac disease in diabetes?
A range of short and long term improvements are possible in individuals with T1DM who are diagnosed with coeliac disease and follow a gluten-free diet.These include:
- Normal growth in children.
- Normal haematological findings including, haemoglobin, folate and B12 levels.
- Improvements HbA1c
Dietary management of Type 1 diabetes and coeliac disease
Dietary management of the combined diseases requires professional guidance from a Registered Dietitian. There are British Society of Gastroenterology guidelines on the management of coeliac disease. These recommend dietetic intervention at diagnosis, 3-months, 6-months and annual review. The role of the dietitian is well documented in diabetes management and there are nutrition guidelines and recommendations for dietetic intervention in diabetes care. Dietary management needs to aim to normalize blood glucose levels as well as support adherence to the gluten-free diet. Particular care needs to be taken in dietetic provision in children with coeliac disease and T1DM diabetes with careful monitoring of growth and development parameters. Courtesy of Coeliac UK(published with permission in writing from:http://www.coeliac.co.uk/)
