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aklap
Joined: 02 Oct 2004
Posts: 7791
Location: WI, USA
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 Posted: Wed Apr 30, 2008 7:08 pm Post subject: CD: An Important Comorbibity Associated With Type 1 Diabetes |
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http://clinical.diabetesjournals.org/cgi/content/extract/26/2/85
| Quote: | Case Study
Celiac Disease: An Important Comorbibity Associated With Type 1 Diabetes
Clinical Diabetes 26:85-87, 2008
DOI: 10.2337/diaclin.26.2.85
Elizabeth A. Fasy, MD and Guillermo Umpierrez, MD
A.M. is a 33-year-old white woman with a history of type 1 diabetes diagnosed at 19 years and complicated by microalbuminuria. She was treated with multiple insulin injections until 2003, when she started on insulin pump therapy. Her hemoglobin A1c (A1C) levels have ranged between 7.0 and 7.5% during the past 3 years. She has history of anxiety disorder and tobacco use.
During a clinic visit, A.M. complained of a slow, steady weight loss of 20 lb during the past year. She admitted to rare postprandial bloating and some early satiety, but no diarrhea. She reported no significant changes in her diet or exercise and denied any changes in her bowel movements, nausea, fever, night sweating, skin hyperpigmentation, lightheadedness, or dizziness after standing.
Her physical examination revealed a thin, well-nourished young woman. She had no goiter, no ophthalmopathy, no hyperhidrosis, and no tremor. Laboratory tests, including hematocrit and hemoglobin, creatinine, potassium, and sodium measurement were all normal. She had no evidence of iron deficiency anemia and a normal complete blood count. Her liver function tests were normal, as were levels of vitamin B12, folate, and calcium. Her thyroid function tests revealed a morning cortisol of 10.3 mg/dl, thyroid-stimulating hormone (TSH) level of < 0.01 mU/ml (normal range: 0.6-3.3), total triiodothyronine (TT3) level of 1.9 nmol/l (normal range: 1.0-1.7), and thyroxine (T4) level of 9.2 µg/dl (normal range: 5.5-11).
The patient was started on 50 mg propylthiouracil (PTU) three times daily. After 4 months of therapy, her TSH level was 0.32 mU/ml, TT3 was 1.6 nmol/l, and TT4 was 8.6 µg/dl. She has continued on PTU.
A.M. was still concerned about her difficulties gaining weight. She reported a good appetite. Because of her persistent weight loss despite improvement in thyroid function studies, immunoglobulin A (IgA) antiendomysial antibodies were checked, with . . . |
Full Text of Article
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| Quote: | Because of the availability of serological screening, more cases of mild celiac disease are now being diagnosed. In one study estimating the prevalence of celiac disease in adults with type 1 diabetes, patients who were screened and found to have positive antibodies and positive findings on small bowel biopsy typically had no symptoms.2 Patients often have nonspecific complaints, such as fatigue. They may have borderline iron deficiency, elevations in aminotransferases, or no symptoms at all. Once patients are placed on a gluten-free diet, they report objective and subjective improvement in well-being regardless of whether they recognized symptoms before diagnosis.
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| Quote: | | The prevalence rates of celiac disease in children with type 1 diabetes are estimated to be between 1.7 and 12%. Screening studies have shown the prevalence among adults with type 1 diabetes to be similar, between 1.3 and 6.4%, which is 10 times the prevalence in the general population. |
| Quote: | | Of children with type 1 diabetes, 16% have been shown to have positive antibodies, and of these, 6.2% had definitive biopsy changes consistent for celiac disease despite being asymptomatic. |
| Quote: | | The 2008 American Diabetes Association clinical practice recommendations state that antibody screening should be performed in patients with type 1 diabetes with suggestive symptomatology, such as iron deficiency anemia, weight loss, or unexplained fatigue. |
Hey - they just got done saying that it can present with no symptoms at all. However, they recommend to test T1D patients with suggestive symptomatology? Am I missing something? Shouldn't they be testing all of them to catch the asymptomatic ones too?
Thanks to Ellen at Children with Diabetes Celiac Forum for sharing this!
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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