Celiac disease is an autoimmune disorder, a condition in which the body’s defense mechanisms start attacking its own cells with
its fighting machines, called antibodies. The patient becomes intolerant to gluten, a group of proteins found in wheat, barley, rye and many other foodgrains. Thus he/she must maintain a gluten-free diet (GFD) for life to prevent complications.
Another long-term disorder in children is type 1 diabetes mellitus (T1DM). The body produces an insufficient amount of insulin which leads to high blood glucose levels and other manifestations at a later stage such as the involvement of kidneys, eyes, genitals, and other organs.
Studies have shown coexistence of T1DM and CD in patients because of similar genetic causation for both diseases. Data shows the prevalence of CD in the general population to be about 1% whereas, in patients suffering from T1DM, it ranges between 5-7%. There is variability in prevalence and coexistence of the two diseases depending upon geographical and genetic predisposition. In India, the north displays comparatively higher prevalence as compared to the south.
Dr. Anju Seth and coworkers at the Department of Pediatrics, Lady Hardinge Medical College, New Delhi took a retrospective look at samples collected during the period – January 2006 to May 2014 and assessed the co-existence of T1DM and CD in children.
They reviewed the records of 126 children and adolescents (62 boys and 64 girls) with T1DM, mean age of 8.2±4 yr. (boys) and 8.1±3.8 yr. (girls). Using biochemical assays like antibody detection and biopsies, they found that 13.5% children with T1DM were suffering from CD as well.
Another observation is the short stature of children with T1DM and CD and coexisting thyroiditis, an autoimmune disorder affecting the thyroid gland that produces hormones regulating growth and development.
In the majority of the cases worldwide, diagnosis of T1DM precedes CD, though the order may be reversed in some. The researchers suggest that it is very important to screen for CD in the early years of detection of T1DM in patients. Alarming symptoms could be sudden changes in blood glucose levels and reduced growth. Failure to do so would increase the risk of T1DM patients to growth retardation, infertility, and gastrointestinal lymphoma (cancer of the gut). Further, they speculate that T1DM patients with undetected CD having continuous exposure to gluten-containing food have a higher chance of developing other autoimmune diseases. Thus, it is very important to test for CD in patients suffering from T1DM to prevent long-term complications.
The authors have shown a higher prevalence of CD in children suffering from T1DM. Since the study was limited by retrospective analysis and variable follow-up of the patients, a more vigorous study plan would further confirm the findings.
The article was published in Indian Journal of Medical Research, January 2017 issue. The team comprised of Preeti Singh, Anju Seth, Praveen Kumar and Sushma Sajjan at the Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India.