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Screening for Celiac Disease

September 15, 2021
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Celiac disease is an autoimmune condition where the body reacts to gluten, a protein that is found in foods such as wheat, barley, and rye.1 When someone with celiac disease consumes gluten, it can damage the lining of the small intestine and cause absorption issues. This can further complicate blood glucose management if the person has type 1 diabetes.

Common symptoms of celiac Include:1

  • Bloating
  • Abdominal Pain
  • Chronic diarrhea or constipation
  • Increased gas
  • Nausea or Vomiting
  • Loose, greasy and bad-smelling stool
  • Slowed growth in children
  • Headaches, joint or bone pain
  • Fatigue, or feeling tired
  • Skin rash called dermatitis herpetiformis

Research shows that between 4 to 9% of people with type 1 diabetes also have celiac disease.2 Screening is not always consistent for people with diabetes, and since many people with celiac do not show symptoms, the diagnosis can be missed. Some health care providers will regularly do bloodwork on people with type 1 diabetes to see if they have celiac.

If your diabetes care provider has not done this screening, here is some data from this retrospective study on celiac and type 1 diabetes screenings published September 6, 2021:

  • 106 patients with type 1 diabetes and celiac disease were included in the study
  • The average age was 13 +/- 5 years
  • 3% of patients were diagnosed with celiac disease within the first year of type 1 diabetes diagnosis
  • 6% were diagnosed with celiac within five years of type 1 diabetes diagnosis
  • It still can occur much later, and one patient in this study was diagnosed with celiac 26 years after t1d diagnosis
  • 83% had no family history of celiac disease
  • At the time of celiac diagnosis, 59.4% of patients did not have any symptoms of celiac disease

Based on these results, the authors propose screening for celiac disease in people with type 1 diabetes for up to eight years after diagnosis, or in the presence of symptoms. Typical screening starts with a blood test of anti-tissue transglutaminase (tTG), and if it’s positive a biopsy of the duodenum will confirm the diagnosis.

The biopsy is collected through an endoscopy, which is where a flexible tube with a light and camera is inserted into the esophagus and down into the stomach and small intestine. This is typically conducted in a medical center that specializes in these types of procedures and done under conscious sedation, which means that you will not remember the procedure.

If you think you need to get screened for celiac, or have your child screened, ask your health care team about getting the tTG test and see if they can order it for you with the next bloodwork you have completed. If you end up needing to alter your diet, check out our page on celiac which has resources for PWD with celiac.

If you have celiac and type 1 diabetes, you are by no means alone in this journey. We have many families and PWD who come to Friends for Life conferences and enjoy our convenient gluten-free buffets. It’s also becoming more common place for restaurants to have gluten-free menu options, making life a little bit easier when you have to live gluten free.

References

  1. Celiac Disease Page by CWD
  2. Optimal Frequency to Screen Celiac Disease amongst Patients with Type 1 Diabetes Mellitus: A Multicenter Study

 


Written and clinically reviewed by Marissa Town, RN, BSN, CDCES