Celiac disease in subjects with type 1 diabetes mellitus: a prevalence study in western Sicily (Italy)
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ORIGINAL ARTICLE
Celiac disease in subjects with type 1 diabetes mellitus: a prevalence study in western Sicily (Italy) Domenico Greco • Maria Pisciotta • Francesco Gambina • Filippo Maggio
Received: 24 March 2012 / Accepted: 25 May 2012 / Published online: 16 June 2012 Ó Springer Science+Business Media, LLC 2012
Abstract The association between celiac disease and type 1 diabetes mellitus is well known. Up to now, celiac disease prevalence in children and adults with type 1 diabetes in Sicily has not been reported. The aim of this study was to assess the prevalence of celiac disease in patients with type 1 diabetes mellitus who come from a defined geographical area in western Sicily and to investigate the clinical features of these subjects. The records of 492 consecutive patients with type 1 diabetes mellitus referred in a period of 5 years were analyzed. During the period of the survey, out of 492 patients with type 1 diabetes, 22 (4.5 %) had a previous diagnosis of celiac disease. There were 14 females and 8 males; these patients showed a mean age of 13 years at diabetes onset. Diagnosis of celiac disease was often simultaneous or subsequent to that of diabetes. Autoimmune thyroiditis was coexisting in 8 patients (36 %). Our data confirm, in a Sicilian population, the not unusual association between celiac disease and type 1 diabetes, although prevalence rate is lower than in others Italian studies. Autoimmune thyroiditis is present with high prevalence in these patients. Celiac disease diagnosis often followed onset of type 1 diabetes, particularly in female subjects with a young age at diabetes onset; therefore, in these subjects, an active search for the presence of celiac disease is warranted for many years after appearance of diabetes.
D. Greco M. Pisciotta F. Gambina F. Maggio Division of Diabetology, Paolo Borsellino Hospital, Marsala, Italy D. Greco (&) Via Cosenza, 155, 91016 Erice, TP, Italy e-mail: [email protected]
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Keywords Type 1 diabetes mellitus Celiac disease Prevalence Autoimmune thyroiditis
Introduction The association between type 1 diabetes and celiac disease (CD) has long been recognized in many populations: in several studies of children and adults with type 1 diabetes, a high prevalence of CD has been found [1–3]. The prevalence rates of CD in subjects with type 1 diabetes are estimated to be between 1.5 and 10 % which is more than 10 times the prevalence in the general population. Heterogeneity has been described in the natural history of CD in type 1 diabetes: it may be disclosed before, at the onset of diabetes or during the follow-up; moreover, in diabetic subjects, many cases of CD are asymptomatic or have features that are only recognized retrospectively. In one study estimating the prevalence of CD in adults with type 1 diabetes, patients who were screened and found to have positive antibodies and positive findings on small bowel biopsy, typically had no symptoms [4]. However, in diabetic patients, because of the availability of serological screening, more cases
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