Evidence suggests that individuals with other autoimmune conditions may have an increased risk of developing celiac disease . The prevalence of autoimmune conditions in individuals with celiac disease may be as high as 14% compared to a rate of 2.8% in the general population. This increase prevalence of celiac disease in other autoimmune conditions warrants screening of these populations.
A list of conditions associated with celiac disease is provided below. Celiac disease has been reported to have an increased prevalence amongst patients with autoimmune thyroid disease (up to 7%), irritable bowel syndrome (up to 7%), and type 1 diabetes (8 - 10%), Downs syndrome (5 - 12 %), Turners syndrome (4 - 8 %), and Williams syndrome (8.2%) (1). Screening of all children, even those who are asymptomatic, in these at risk groups is recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) after three years of age .
Celiac disease may also have an increased prevalence in the following conditions
Autoimmune liver conditions
Chronic thrombocytopenia purpura
Type 1 diabetes
Type 1 diabetes
Celiac disease and type 1 diabetes often occur together. About 10% of Type 1 diabetics develop celiac disease. Celiac disease is often found on a routine screening, as many diabetics with celiac disease are asymptomatic. Celiac disease is also frequently found in first-degree relatives of type 1 diabetics. In the vast majority of patients celiac disease diagnosis follows the diagnosis of type 1 diabetes.
The joint occurrence of the two diseases appears to be linked by the presence of histocompatibility genes specifically the occurrence of HLA-DQ2 and HLA-DQ8.
Screening for celiac disease in type 1 diabetics
Similarly to celiac disease, the incidence of type 1 diabetes is rising, with a reported increase of 3% annually . Less than 10% of patients with type 1 diabetes and celiac disease report gastrointestinal symptoms , therefore, routine screening for celiac disease in this patient group is strongly recommended. Annual screening of type 1 patients is recommended by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) . Current ESPGHAN guidelines recommend screening every 2 to 3 years .
Impact of a dual diagnosis
Evidence suggests that children with both type 1 diabetes and celiac disease have lower weight and height standard deviation scores. Furthermore, good adherence to a gluten free diet appears to result in steady improvement in height and weight while poor adherence is likely to result in continued growth impairment . Among adults newly diagnosed with celiac disease, glycemic control has been shown to be significantly worse than among those with type 1 diabetes alone , although this effect may be reduced over time as the gluten free diet becomes well established [5,8]. Malabsorption of carbohydrates secondary to mucosal damage may explain the observation that episodes of hypoglycemia are more common in patients with type 1 diabetes and celiac disease in the six months before and after celiac diagnosis. Once again, this finding is not repeated upon longer term follow up of patients, indicating gut recovery on a gluten free diet .
Long term risk
Unfortunately the prevalence of longer term complications associated with diabetes appear to be significantly greater for patients with both conditions, compared to those with diabetes and/or celiac disease alone. Both risk of retinopathy  and subclinical atherosclerosis  is increased for those with a dual diagnosis in the longer term. Overall mortality risk after the first 5 years post celiac diagnosis also appears to increase over time for those with both type 1 diabetes and celiac disease .
Dietary therapy for diabetes and celiac disease
A strict gluten free diet is required in order to maintain glycemic control and reduce the short and long term complications of both diseases. The dietary management of both conditions is based on general healthy eating principles that apply to the population as a whole for the purpose of disease risk reduction and promotion of optimal health. Weight control and exercise are also paramount to glycemic control.
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