Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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ISSN 1899–5276 (print)
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Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 2, March-April, p. 297–301

Publication type: review article

Language: English

Creative Commons BY-NC-ND 3.0 Open Access

Celiac Disease and Diabetes Mellitus

Celiakia a cukrzyca

Ewa Waszczuk1,, Małgorzata Kosiara1,, Tadeusz Dobosz1,, Leszek Paradowski1,

1 Chair and Department of Gastroenterology and Hepatology, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Celiac disease is a multifactorial disease involving both genetic and environmental factors. It is characterized by the presence of DQ2(DQA1*0501, DQB2*201) heterodimer in 90% of patient with celiac disease. The prevalence of celiac disease is about 1%. Autoimmune conditions such diabetes mellitus, dermatitis herpetiformis and thyroid disease may coexist with celiac disease. In individuals with type 1 diabetes mellitus prevalence of celiac disease range 10%, but in people with type 2 diabetes mellitus the frequency is similar to that of the general population. It is associated with the HLA markers B8 and DR3. Early detection of celiac disease and early treatment with a gluten−free diet may avoid many complications like: malnutrition, folic acid deficiency, anaemia, bone disease and malignancy especially lymphoma. Patients with diabetes mellitus and not−treated celiac disease have increased risk of symptomatic hypoglycemia. During taking gluten−free diet mean daily insulin requirement is higher, metabolic control is better and more seldom hypoglycemia occurs. Now, it is proposed that every patient with type 1 diabetes mellitus should be investigated for celiac disease, because clinical symptoms of celiac disease not always are clear, and early treatment allows avoiding many severe complications.

Streszczenie

Celiakia jest wieloczynnikową chorobą, na której występowanie mają wpływ zarówno czynniki genetyczne, jak i środowiskowe. U 90% osób chorych na celiakię występuje haplotyp DQ2(DQA1*0501,DQB1*0201). Częstość występowania celiakii wynosi około 1%. Współistnieją z nią inne choroby autoimmunologiczne, takie jak: cukrzyca typu 1, dermatitis herpetiformis lub choroby tarczycy. Wśród pacjentów z cukrzycą typu 1 celiakia występuje u prawie 10%, a u pacjentów z cukrzycą typu 2 z częstością podobną jak w populacji ogólnej. Jest to związane ze wspólnym podłożem genetycznym celiakii i cukrzycy typu 1 – antygenami HLA B8 i DR3. Wczesne rozpoznanie choroby trzewnej i stosowanie diety bezglutenowej pozwala uniknąć wielu powikłań, takich jak: zaburzenia neurologiczne, niedokrwistość, osteoporoza i nowotwory złośliwe, a wśród nich szczególnie chłoniaki. U pacjentów z cukrzycą typu 1 i nieleczoną celiakią istnieje zwiększone ryzyko objawowej hipoglikemii. Podczas stosowania diety bezglutenowej poprawiały się wskaźniki gospodarki węglowodanowej i rzadziej występowały epizody hipoglikemii. Obecnie proponuje się wykonywanie badań przesiewowych u wszystkich pacjentów z cukrzycą typu 1 ze względu na to, że nie zawsze obraz kliniczny współistniejącej choroby trzewnej jest klarowny, a wczesne rozpoznanie celiakii pozwala uniknąć poważnych powikłań.

Key words

celiac disease, diabetes mellitus type 1, genetic predisposition

Słowa kluczowe

celiakia, cukrzyca typu 1, predyspozycja genetyczna

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