Screening Practices and Management of Celiac Disease and Type 1 Diabetes

The Celiac Disease Center at Columbia University

Nov 16, 2010

Both celiac disease (CD) and type 1 diabetes (T1D) are autoimmune diseases. In CD the immune response is triggered by the ingestion of gluten, resulting in chronic inflammation and villous atrophy in the small intestine. Treatment requires permanent elimination of gluten from the diet. In T1D, pancreatic islet beta cells are damaged resulting in loss of endogenous insulin production. Treatment includes daily insulin injections combined with meal planning and exercise. Nutrition management of the individual with both T1D and CD can be challenging for both the patient and the dietitian.

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The Celiac Disease Center at Columbia University is doing a research study on the screening practices of diabetes clinics for celiac disease. The survey will take less than 10 minutes to complete.

Please consider filling out the survey and passing it onto fellow Type 1 Diabetes professionals.

http://www.surveymonkey.com/s/8RBGNNY

Many thanks,

Suzanne Simpson, RD, Celiac Disease Center at Columbia University

Shelley Case, RD, Medical Advisory Board: Celiac Disease Foundation, Gluten Intolerance Group, Canadian Celiac Association

Nancee Jaffe, Graduate Student, MS and CDP, CSULA 2012

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Numerous studies have shown the prevalence of CD in patients with T1D to be much higher (2%-12.3%) than the prevalence of CD in the general population (1%). Because of the high prevalence and frequent lack of symptoms, screening for CD in the T1D population is recommended. Screening tests include the IgA endomysial antibodies (EMA) and IgA tissue transglutaminase antibodies (TTG). Some investigators recommend that a positive TTG be followed by a positive EMA before biopsy in patients with T1D. There is no age limit for screening. Seroconversion (positive antibodies) can occur at diagnosis or at any time during follow-up.

Because of the strong correlation between CD and T1D, it is important to determine what the screening practices are for the occurrence of CD screening once T1D is diagnosed in a patient. To this date, there is minimal data on the screening practices in diabetes centers throughout North America. This data would be beneficial in order to develop more stringent recommendations about screening recommendations.

The American Diabetes Association (ADA) 2005 statement for Care of Children and Adolescents with Type 1 Diabetes recommends that: "Patients with T1D should be screened for CD, using TTG antibodies, or EMA, with documented normal serum IgA levels. Testing should occur after the diagnosis of T1D and subsequently if growth failure, failure to gain weight, weight loss, or gastroenterological symptoms occur".

The survey will be submitted via the email program Survey Monkey in September and October 2010 to such organizations as the Diabetes Care & Education practice group of the American Dietetic Association, the Dietitians of Canada, the American Diabetes Association, the Canadian Diabetes Association and diabetes education centers in Canada and the United States.   The survey will investigate whether patients with T1D are screened for CD, how often and using what tests. The survey will also look at the treatment recommendations that are provided to patients with T1D if they are diagnosed with CD.  

We hypothesize that screening protocols will vary from institution to institution. The information gained from the survey will reveal current practices for screening and management of CD in T1D in North America. This information will be shared with practitioners in a variety of ways, including dietetic practice groups, diabetes associations and other appropriate organizations. In addition, the data will be included in a journal article on CD and T1D. By sharing this information, it is hoped that a more consistent and effective approach to screening and managing CD and T1D will occur, generating more discussion on the topic and a better outcome for improved patient care.

References
1. NASPGHAN. Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005;40 (1):1-19.
2. Goh C, Banerjee K. Prevalence of celiac disease in children and adolescents with type 1 diabetes mellitus in a clinic-based population. Postgrad Med J. 2007;83:132-136.
3. Valletta E, Ulmi D, Mabboni I, et al. Early diagnosis and treatment of celiac disease in type 1 diabetes. A longitudinal, case-control study. Pediatr Med Chir. 2007;29:99-104.
4. Cerutti F, Bruno G, Chiarelli F, et al. The Diabetes Study Group of Italian Society of Pediatric Endocrinology and Diabetology. Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes: An Italian multicenter study. Diabetes Care. 2005;27(6):1294-1298.
5. Franzese A, Spagnuolo MI, Valerio G. Diabetic children with asymptomatic celiac disease: Is it necessary to stress gluten-free diet? Clin Nutr. 2004;23:281-282.
6. Comorbid Conditions in Children with Type 1 Diabetes- 2003. Canadian Diabetes Association. Appendix 13: Clinical Practice Guidelines, 2003.
7. Freemark M, Levitsky L. Screening for celiac disease in children with type 1 diabetes. Diabetes Care. 2003;26(6):1932-1939.
8. Hansen D, Brock-Jacobsen B, Lund E, et al. Clinical benefit of a gluten-free diet in Type 1 diabetic children with screening-detected celiac disease. Diabetes Care. 2006;29(11):2452-2456.
9. Kupper C, Higgins LA. Combining diabetes and gluten-free dietary management guidelines. Pract Gastroenterol. 2007;March:68-83.
10. Sanches-Albisua I, Wolf J, Neu A, et al. Coeliac disease in children with Type 1 diabetes mellitus: The effect of the gluten-free diet. Diabet Med. 2005;22:1079-1082.
11. Saukkonen T, Vaisanen S, Akerblom HK, Savilahti E. The Childhood Diabetes Finland Study Group. Coeliac disease in children and adolescents with type 1 diabetes: A study of growth, glycaemic control, and experiences of families. Acta Paediatrica. 2002;91:297-302.
12. Amin R, Murphy N, Edge J, et al. A longitudinal study of the effects of a gluten-free diet on glycemic control and weight gain in subjects with type 1 diabetes and celiac disease. Diabetes Care. 2002;25(7):1117-1122.

13. Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes-2006: A position statement of the American Diabetes Association. Diabetes Care. 2006;29(9):2140-2157.

14. Sud S, Marcon M, Assor E, Palmert MR, Daneman D, Mahmud FH. Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas. 2010. International Journal of Pediatric Endocrinology. 2010;161285:15.

 

 

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