Celiac disease in patients with type-1 diabetes mellitus screened by tissue transglutaminase antibodies in southern Kerala, India

Abstract

BACKGROUND: High prevalence rates of celiac disease (CD) in patients with type-1 diabetes mellitus (T1DM) have been reported in several countries. However, the data regarding this association are scarce in Southern Kerala, India. In this study, we report the prevalence of CD in patients with T1DM in southern Kerala using tissue transglutaminase antibodies (tTGA) as a screening test. METHADOLOGY: One hundred patients with T1DM (58 women and 42 men) aged 21.8 ± 8.86 years (age range: 7-50 years) were compared with 150 healthy people (82 women and 68 men) aged 28.9 ± 9.07 years (age range: 4-50 years). All subjects were serologically screened for the presence of tTGA. Total immunoglobin A (IgA) was obtained to investigate IgA deficiency. Subjects positive for tTGA and deficient for IgA were submitted to upper gastrointestinal endoscopy. RESULTS: Eight patients with T1DM (8%) and three of the controls (2%) were positive for tTGA (P=0.023), while only 3% of the tTGA positive T1DM patients underwent duodenal biopsy and all of them showed partial or total villous atrophy. The mean age of tTGA, positive cases were significantly lower than tTGA negative ones (mean difference 7.17; 95% CI: 0.82-13.52). None of the tTGA positive T1DM patients had a history of chronic diarrhea, but one out of eight tTGA positives reported history of dermatitis (P=0.001). In addition, none of the tTGA positive subjects presented IgA deficiency. There was a significant difference in history of chronic diarrhea (P= 0.006) and autoimmune diseases (P =0.001) between patients with T1DM and controls. CONCLUSION: This study showed higher prevalence of CD in patients with T1DM than in general population of southern Kerala and the data lend support to recommend regular screening for CD in all patients with T1DM.