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Celiac disease in type 1 diabetes mellitus

Maria Erminia Camarca1, Enza Mozzillo12, Rosa Nugnes13, Eugenio Zito1, Mariateresa Falco1, Valentina Fattorusso1, Sara Mobilia1, Pietro Buono1, Giuliana Valerio2, Riccardo Troncone1 and Adriana Franzese1*

Author Affiliations

1 Department of Paediatrics, "Federico II" University, Naples, Italy

2 School of Movement Sciences (DiSIST)- Parthenope University, Naples, Italy

3 Department of Cellular and Molecular Pathology "L. Califano", "Federico II" University, Naples, Italy

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Italian Journal of Pediatrics 2012, 38:10  doi:10.1186/1824-7288-38-10

Published: 26 March 2012

Abstract

Celiac Disease (CD) occurs in patients with Type 1 Diabetes (T1D) ranging the prevalence of 4.4-11.1% versus 0.5% of the general population. The mechanism of association of these two diseases involves a shared genetic background: HLA genotype DR3-DQ2 and DR4-DQ8 are strongly associated with T1D, DR3-DQ2 with CD. The classical severe presentation of CD rarely occurs in T1D patients, but more often patients have few/mild symptoms of CD or are completely asymptomatic (silent CD). In fact diagnosis of CD is regularly performed by means of the screening in T1D patients. The effects of gluten-free diet (GFD) on the growth and T1D metabolic control in CD/T1D patient are controversial. Regarding of the GFD composition, there is a debate on the higher glycaemic index of gluten-free foods respect to gluten-containing foods; furthermore GFD could be poorer of fibers and richer of fat. The adherence to GFD by children with CD-T1D has been reported generally below 50%, lower respect to the 73% of CD patients, a lower compliance being more frequent among asymptomatic patients. The more severe problems of GFD adherence usually occur during adolescence when in GFD non compliant subjects the lowest quality of life is reported. A psychological and educational support should be provided for these patients.

Keywords:
Diabetes; Celiac disease; Genetic background; HLA; Dietetic compliance; Glycaemic index; Gluten free diet; Quality of life