Home

Classic symptoms of celiac disease generally include steatorrhea, flatulence, and the consequences of malabsorption, such as growth failure in children, weight loss, severe iron deficiency anemia, neurological disorders from vitamin B deficiencies, and osteopenia from vitamin D and calcium deficiencies. Patients with positive antibodies should be referred to a gastroenterologist for confirmation and to a dietitian for instruction on a glutenfree diet.6 Adherence to a gluten-free diet has been shown to significantly reduce the risk of small bowel lymphoma and nutritional deficiencies of iron, vitamin B12, zinc, calcium, magnesium, and fatsoluble vitamins in patients with celiac disease.7 However, only a handful of small prospective studies have addressed the issue of the glycemic benefits of a gluten-free diet.

CLINICAL PEARLS

* Individuals with type 1 diabetes and celiac disease often do not have overt gastrointestinal complaints. They often present with mild constitutional symptoms of weight loss and fatigue with the development of celiac disease. Because of the high prevalence and minimal symptomatology of celiac disease in patients with type 1 diabetes, health care providers should have a low threshold for screening for IgA anti-tissue transglutaminase and IgA endomysial antibodies.

* Evidence of celiac disease is present in a high percentage of children at the time of diagnosis of type 1 diabetes, and these individuals typically develop celiac disease within 4 years of their diabetes diagnosis. In contrast, autoimmune thyroid disease typically follows the diagnosis of diabetes by an average of 10 years. Thus, screening for celiac disease should be considered early in young individuals with diabetes, whereas screening for thyroid disease should be considered for decades after diabetes diagnosis.

* Dietary management of celiac disease improves symptomatology, increases weight, and decreases the risk of osteopenia and malignant lymphoma without any significant change in glycemic control.