NEW ORLEANS — As many as one in 20 patients with type 1 diabetes may have celiac disease. However, many may not necessarily present with gastrointestinal (GI) symptoms and, in some cases, may be asymptomatic, according to nutritionist Marilyn McCall, MA, RDN, LDN, who is with the Diabetes Education Program at Jones Regional Medical Center in Anamosa, Iowa.
McCall discussed celiac disease in patients with type 1 diabetes at during a session at AADE 2015, the annual meeting of the American Association of Diabetes Educators.
One percent of the U.S. population has or will develop celiac disease, including 290,000 individuals with comorbid diabetes, according to McCall. Endocrinologists commonly see patients with gluten-intolerant disorders and comorbid diabetes. Managing the two, she said, can be very difficult.
On top of that, when individuals have one autoimmune disease, they frequently have more than one, with the triad of celiac disease, type 1 diabetes and hypothyroidism being very common, McCall added.
“Obtaining an accurate and timely diagnosis will provide the best possible care and assist in delaying or avoiding long-term consequences such as shorter stature, other food intolerances, nutritional deficiencies related to malabsorption, infertility and problem pregnancies,” said McCall.
Celiac disease can present in anyone and at any age if they are genetically predisposed. It is now estimated that 40% of the U.S. population is genetically prone to celiac disease.
“This means that even though a blood screening came back negative 3 years ago, it should be repeated. And if the blood screening is negative and there is still reason to suspect, a biopsy, which must include four to six sights, should be ordered. However, if a person has the resources to have genetic testing done, then unnecessary time and testing can be avoided,” McCall told Endocrinology Advisor.
She said managing celiac disease alone includes working with a registered dietitian, the patient and the patient’s family to identify sources of accidental gluten. McCall also suggests that medications, including thyroid medications, should be reviewed periodically and adjusted as needed.
In addition, all medications should be screened periodically for any changes in their formula. McCall said a few years ago, a popular thyroid medication changed. The new formula included gluten, which caused many patients with celiac disease to wonder why they were experiencing symptoms.
“It was only after being informed by a listserv that I belong to that I was able to assist several people with identifying the offending medication that was making them very ill. Some were sent to the hospital,” said McCall.
Therefore, it is imperative that clinicians set up effective programs for self-management that facilitate lifestyle modification to help prevent or delay chronic disease and improve outcomes, according to McCall. She identified new methodologies that are now showing success in supporting and enhancing improvements in quality of life.
Gluten is a protein found in wheat, barley (malt) and rye. “Gluten-related disorder” is a general term to encompass all of the various reactions to gluten.
Surprisingly, McCall said 85% of individuals with a gluten-related disorder remain undiagnosed.
“This is actually down from 95%. Doctors were told it was a rare condition. The only treatment is a gluten-free diet — no pills or surgery,” said McCall.
She said clinicians might suspect the disorder in a child with failure to thrive if he or she also has some GI issues. But a common first symptom is fatigue and migraine-like headaches. She said unfortunately, the tendency is to treat the symptom and not the disease.
- McCall M. S04 – To Eat Or Not To Eat Gluten: This is Just One Of the Questions. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.