title: High prevalence of microvascular complications in adults with type 1 diabetes and newly diagnosed celiac disease.
abstract: OBJECTIVE
  The implications of celiac disease (CD) in adult patients with type 1 diabetes are unknown, with respect to diabetes-related outcomes including glycemic control, lipids, microvascular complications, quality of life, and the effect of a gluten-free diet (GFD). We identified CD in adults with type 1 diabetes and investigated the effect of a GFD on diabetes-related complications.
  
  
  METHODS
  This was a case-control study conducted at a U.K. teaching hospital. Patients with type 1 diabetes aged >16 years (n = 1,000) were assessed for CD. HbA(1c), lipid profile, quality of life, retinopathy stage, nephropathy stage, and degree of neuropathy before and after 1 year on a GFD were assessed.
  
  
  RESULTS
  The prevalence of CD was 33 per 1,000 subjects (3.3% [95% CI 2.3-4.6]). At diagnosis of CD, adult type 1 diabetic patients had worse glycemic control (8.2 vs. 7.5%, P = 0.05), lower total cholesterol (4.1 vs. 4.9, P = 0.014), lower HDL cholesterol (1.1 vs. 1.6, P = 0.017), and a higher prevalence of retinopathy (58.3 vs. 25%, P = 0.02), nephropathy (41.6 vs. 4.2%, P = 0.009), and peripheral neuropathy (41.6 vs. 16.6%, P = 0.11). There was no difference in quality of life (P > 0.1). After 1 year on a GFD, only the lipid profile improved overall, but in adherent individuals HbA(1c) and markers for nephropathy improved.
  
  
  CONCLUSIONS
  Adults with undetected CD and type 1 diabetes have worse glycemic control and a higher prevalence of retinopathy and nephropathy. Treatment with a GFD for 1 year is safe in adults with type 1 diabetes and does not have a negative impact on the quality of life.
authors.affiliation: Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. jsleeds@hotmail.com
authors.forename: John S
authors.initials: JS
authors.lastname: Leeds
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hopper
authors.forename: Marios
authors.initials: M
authors.lastname: Hadjivassiliou
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D002446:Celiac Disease / Q000097:blood / Q000150:complications* / Q000178:diet therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000178:diet therapy; D003928:Diabetic Nephropathies / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D003930:Diabetic Retinopathy / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
chemical_list: D001786:Blood Glucose