Adolescent boys and girls with type 1 diabetes (T1D) and celiac disease (CD) have an increased risk for depression, highlighting the importance of depression screenings as part of routine care, particularly in patients with celiac disease, according to research published in Acta Diabetologica last month.

“We found a positive association between celiac disease and depression among children and young adults with T1D. Our study confirms this association for usually asymptomatic celiac disease in patients with T1D,” wrote authors who were led by Maria E. Craig, MBBS, PHD, of the Institute of Endocrinology and Diabetes at The Children’s Hospital at Westmead, Australia.

Approximately 5% of patients with type 1 diabetes also have celiac disease, which, according to previously published studies, has been shown to be associated with anxiety and depression in adult patients, but the same associations have never before been explored in a pediatric population.


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THE STUDY

Craig et al. identified 79,067 adolescent male and female adolescent patients with type 1 diabetes (mean age 16.5 years). The patients were categorized into 4 groups: T1D only (n=73,699), T1D with celiac disease (n=3379), T1D with depression (n=1877), or T1D with celiac disease and depression (n=112).

Results indicated a significant association between celiac disease and depression (adjusted odds ratio, 1.25; 95% CI, 1.03-1.53) affecting 2.5% in patients enrolled in the study. However, the number could be much higher since not all patients are screened for depression. Previous assessments estimate that 12-30% of adolescents and young adults with T1D and celiac disease have depression.

Patients with T1D and celiac disease had a lower adjusted BMI-SDS (0.36) compared to patients with T1D and depression (0.55) and T1D only patients (0.52), although there was no difference between the T1D and celiac disease patients and patients with T1D, celiac disease and depression. Patients with T1D and depression and celiac disease were associated with worse metabolic control compared to patients with T1D only (P <.001).

Compared with the T1D group, HbA1c was higher in both T1D and depression (9% vs 8.2%; P <.001) and the T1D, celiac disease and depression groups (8.0% vs 8.2%; P <.001). Overall, the T1D, celiac disease and depression group experienced higher rates of comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders compared with the T1D only group (all P <.001).

“Early detection of celiac disease is important, since adhering to a gluten-free diet may alleviate depressive symptoms. Having T1D and additional celiac disease is a heavier burden than having only one chronic disease. If we assume that depression develops later than celiac disease, it is not surprising that the double load may lead to an increased risk for depression. However, we cannot say whether the increased risk for depression in celiac disease is due to a restricted diet or due to untreated celiac disease,” authors wrote.

Reference

Tittel SR, Dunstheimer D, Hilgard D, et al; for the HPV Initiative. Coeliac disease is associated with depression in children and young adults with type 1 diabetes: results from a multicentre diabetes registry. Acta Diabetol. Published online January 23, 2021. doi:10.1007/s00592-020-01649-8