title: Microvascular Complications in Childhood-Onset Type 1 Diabetes and Celiac Disease: A Multicenter Longitudinal Analysis of 56,514 Patients From the German-Austrian DPV Database.
abstract: OBJECTIVE
  To investigate whether celiac disease (CD) associated with type 1 diabetes increases the risk of microvascular complications.
  
  
  METHODS
  Patients (n = 56,514) aged >10 years with diabetes duration <20 years from 392 centers in Germany and Austria were assigned to one of three categories (n): no CD (50,933), biopsy-confirmed CD (812), or suspected CD (4,769; clinical diagnosis or positive antibodies). The confirmed and suspected groups were combined and analyzed for retinopathy or nephropathy. Cox proportional hazards regression was used to adjust for potential confounders (glycated hemoglobin [HbA1c], age at diabetes onset, sex, smoking, dyslipidemia, and hypertension).
  
  
  RESULTS
  Kaplan-Meier analysis revealed that retinopathy and nephropathy occurred earlier in the presence versus absence of CD: retinopathy at age 26.7 years (95% CI 23.7-30.2) in 25% of patients with CD vs. age 33.7 years (33.2-34.4) in 25% without CD and microalbuminuria at age 32.8 years (29.7-42.5) vs. 42.4 years (41.4-43.3). The adjusted risk for both retinopathy (hazard ratio 1.263 [95% CI 1.078-1.481]) and nephropathy (1.359 [1.228-1.504]) was higher in patients with diabetes and CD versus those without CD. Cox regression revealed CD as an independent risk factor for microvascular complications after adjustment for confounders.
  
  
  CONCLUSIONS
  CD is an independent risk factor for retinopathy and nephropathy in patients with type 1 diabetes. Our study therefore supports the recommendation for regular serologic testing for CD, even in the absence of clinical CD. Further prospective studies are required to investigate whether a gluten-free diet might reduce the risk of microvascular disorders in patients with diabetes and CD.
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany tilman.rohrer@uks.eu.
authors.forename: Tilman R
authors.initials: TR
authors.lastname: Rohrer
authors.affiliation: Department of Pediatric and Adolescent Medicine, St. Vincenz Hospital, Paderborn, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolf
authors.affiliation: Department of Pediatrics, Technical University Munich, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Liptay
authors.affiliation: Department of General Pediatrics and Neonatology, Children's Hospital, University of Giessen, Giessen, Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Zimmer
authors.affiliation: Department of Pediatrics, Medical University of Graz, Graz, Austria.
authors.forename: Elke
authors.initials: E
authors.lastname: Fröhlich-Reiterer
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Scheuing
authors.affiliation: Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Marg
authors.affiliation: University of Tübingen Children's Hospital, Tübingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.affiliation: Department of Pediatrics, University of Leipzig, Leipzig, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kapellen
authors.affiliation: Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University of Duisburg-Essen, Essen, Germany.
authors.forename: Berthold P
authors.initials: BP
authors.lastname: Hauffa
authors.affiliation: Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wölfle
authors.affiliation: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology; D001317:Austria; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology*; D055050:Diet, Gluten-Free; D050171:Dyslipidemias / Q000150:complications / Q000453:epidemiology; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin