Targeting optimal metabolic parameters in type 1 diabetes and concomitant coeliac disease: an extra challenge

Abstract

Patients, especially children, with Type 1 Diabetes (T1D) have an increased risk of developing other autoimmune disorders including Coeliac Disease (CD) While the prevalence of CD in the general population is approximately 1%, in patients with T1DM, the prevalence of CD is higher with studies reporting rates between 0.6% to 16.4%.Gluten free diet (GFD) imposes practical limitations in dietary options. Many of the gluten-free foods have a high glycemic index. This might influence glycemic values, HbA1c, insulin requirement, lipid profile, and possibly the development of long-term diabetic complications. Moreover, GFD could modify height, weight, body mass index (BMI). In this study we selected the subgroup of pts with T1D attending our service between June 2011 and June 2013 who have concomitant CD (n=30). To determine whether differences exist in their metabolic parameters compared to those of the total cohort of patients with T1D attending our service in the same time-period (n=905), we did a crosssectional analysis of clinic measurements of weight, BMI, BP, HbA1c, lipid profiles, albumin creatinine ratios and Tissue Transglutamine IgG antibody titres (TTG) (as a marker of adherence to a gluten free diet). The CD+T1D group consisted of 18(60%) females and 25 (83%) adults (>18 yrs) and had a mean age of 37 (SD 19). The T1D group consisted of 431(48%) females and 798(88%) adults (>18 yrs) and had a mean age of 37(17). HbA1c in the CD+T1D group was 76.4mmol/mol (SD 17.4) vs. 70.3 (17.7) in the T1D group. There was no difference between males and females, but in both groups children had higher HbA1c values (83.6 and 75.7 respectively). In the CD+T1D group ADA target Chol, Triglyceride, LDL and HDL values were achieved by 87%, 97%, 87%, 93% respectively compared to 73%, 82%, 62% and 85% in the T1D group. 35% of the former were on cholesterol lowering drugs compared with 31% of the latter. The CD+T1D gp had BMI in target in 68% of cases, the T1D gp in 46%. CD+T1D presents a challenge to achieving target HbA1c.