Is Celiac Disease Prevalent Among Type 2 Diabetes Patients?
The incidence of celiac disease (CD) is higher in patients with type 2 diabetes who have inappropriate glycemic control vs the general population, according to a recent study. The results indicate that CD testing may be warranted in these patients.
Although the incidence of CD is high in patients with type 1 diabetes, less is known about its prevalence among patients with type 2 diabetes. Inappropriate glycemic control in patients with type 2 diabetes typically leads to diabetes-related complications. Furthermore, previous studies have suggested that immune factors may be associated with the pathophysiology of insulin resistance and type 2 diabetes.
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For their study, the researchers assessed patients with type 2 diabetes (n = 135) with inappropriate glycemic control, along with healthy controls (n = 115). Inappropriate glycemic control was defined as a hemoglobin A1c (HbA1c) value of less than 7%, despite insulin treatment use for at least 3 months. Insulin treatment was defined as only insulin, or insulin along with oral antidiabetic drugs.
Patients were screened for celiac disease using the immunoglobulin A tissue transglutaminase antibodies (tTGA IgA) test. All patients with elevated tTGA IgA or selective lgA deficiency underwent an upper gastrointestinal endoscopy with duodenal biopsy.
Ultimately, 2 (1.45%) of the 135 patients with type 2 diabetes had also received a CD diagnosis.
Results indicated that patients with diabetes tended to have significantly higher systolic and diastolic blood pressure, waist circumference, fasting plasma glucose, postprandial plasma glucose, urea, sodium, HbA1c, low-density lipoprotein cholesterol, triglyceride, vitamin B12 levels, compared with controls.
Furthermore, patients with type 2 diabetes also had higher body mass index, high-sensitive C-reactive protein levels, microalbuminuria, aspartate aminotransferase, alanine aminotransferase, potassium, and phosphorus levels, compared with controls. However, levels of high-density lipoprotein cholesterol and parathyroid hormone were significantly lower in patients with type 2 diabetes vs controls.
“The prevalence of celiac disease among patients with type 2 diabetes, with poor glycemic control despite insulin therapy, is slightly higher than the actual CD prevalence in general population,” the researchers concluded. “Type 2 diabetic patients with inappropriate control of glycemia in spite of insulin treatment might be additionally tested for Celiac disease especially if they have low C-peptide levels.”
—Christina Vogt
Reference:
Kizilgul M, Ozcelik O, Beysel S, et al. Screening for celiac disease in poorly controlled type 2 diabetes mellitus: worth it or not? [Published online October 6, 2017]. BMD Endocr Disord. https://doi.org/10.1186/s12902-017-0212-4.