title: A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes.
abstract: OBJECTIVE
  Celiac disease (CD) may influence metabolic control in type 1 diabetes (T1D). This work examines whether CD in T1D influences hospital admissions due to coma, ketoacidosis and hypoglycemia.
  
  
  METHODS
  In population-based cohort study, individuals with CD were identified using biopsy data (1969-2008) from Sweden's 28 pathology departments. T1D was defined as a recorded diagnosis of T1D at age ≤30 years in the Swedish National Patient Register between 1964 and 2009. In total, 906 individuals had both T1D and CD and were matched for sex, age and calendar period with 4303 reference individuals. Through stratified Cox regression analysis, we modeled CD as a time-dependent covariate and estimated the risk of future coma, ketoacidosis and hypoglycemia, defined by relevant international classification of disease codes among T1D patients with and without CD.
  
  
  RESULTS
  During follow-up, patients with both T1D and CD had 49 hospital admissions with diabetic coma, 91 episodes of ketoacidosis and 25 hypoglycemic events. Among patients with T1D, CD did not influence the risk of coma (adjusted HR 0.97; 95 % CI 0.72-1.32), ketoacidosis (adjusted HR 1.08; 95 % CI 0.86-1.34), or hypoglycemia (adjusted HR 1.34; 95 % CI 0.87-2.05). The absolute risk of coma was 621/100,000 person-years in T1D and CD (637 in controls). Corresponding figures for ketoacidosis were 1175/100,000 person-years in T1D and CD (1092 in controls) and for hypoglycemia 316/100,000 person-years (236 in controls). HRs for metabolic emergencies in T1D were similar in the first 5 years after T1D diagnosis as thereafter.
  
  
  CONCLUSIONS
  Having a diagnosis of CD is unlikely to influence the risk of coma, ketoacidosis and hypoglycemia in T1D patients.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK. matthew.kurien@sth.nhs.uk.|Academic Unit of Gastroenterology, University of Sheffield, Sheffield, S10 2RX, UK. matthew.kurien@sth.nhs.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden.
authors.forename: Kaziwe
authors.initials: K
authors.lastname: Mollazadegan
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.|Academic Unit of Gastroenterology, University of Sheffield, Sheffield, S10 2RX, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden. jonasludvigsson@yahoo.com.|Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden. jonasludvigsson@yahoo.com.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D003926:Diabetic Coma / Q000453:epidemiology*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011153:Population; D012306:Risk; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult
keywords: Celiac disease; Coma (diabetic); Diabetic ketoacidosis; Hypoglycemia