REVIEW PAPER
Dietary treatment of Coleiac Disease (CD) coexisting with Type 1 Diabetes Mellitus (T1DM)
1
Zakład Medycyny Społecznej i Zdrowia Publicznego, WUM
Corresponding author
Aleksandra Kozłowska
Zakładem Medycyny Społecznej i Zdrowia Publicznego, WUM, Oczki 3, 02-007 Warsaw, Polska
Zakładem Medycyny Społecznej i Zdrowia Publicznego, WUM, Oczki 3, 02-007 Warsaw, Polska
Med Og Nauk Zdr. 2018;24(3):166-171
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Dietary treatment of coeliac disease (CD) and Type 1 diabetes mellitus (T1DM) is an important element of therapy among these patients and is a challenge for health services. Both hypoglycaemia and hyperglycaemia at T1DM, as well as the complex pathogenesis of CD, are associated with an increased risk of various complications in these patients. It has been suggested that the destruction of the small bowel mucosal architecture in those with T1DM but undiagnosed CD, causes malabsorption of nutrients which may cause reduction in glycated haemoglobin A1c (HbA1c) lowers insulin level requirements and increases the frequency of self-reported severe hypoglycaemic episodes. In recent years, an increase in body weight has been observed after introducing a gluten-free diet in patients with coeliac disease. Furthermore, ready-to-eat gluten-free products, most often chosen by patients, are characterized by a low nutritional value and a high glycaemic index. A review of recent literature showed that after introducing the gluten-free diet (GFD) in this group of patients, an increase in body mass was observed. It is highlighted that the early diagnosis of CD among patients with T1DM and initiation of a GFD under regular dietetic supervision may prevent further deterioration in the nutritional status of patients, and may also reduce the prospect of CD complications without having any evident impact on T1DM control. It seems that nutritional education among these patients is important.
Dietary treatment of coeliac disease (CD) and Type 1 diabetes mellitus (T1DM) is an important element of therapy among these patients and is a challenge for health services. Both hypoglycaemia and hyperglycaemia at T1DM, as well as the complex pathogenesis of CD, are associated with an increased risk of various complications in these patients. It has been suggested that the destruction of the small bowel mucosal architecture in those with T1DM but undiagnosed CD, causes malabsorption of nutrients which may cause reduction in glycated haemoglobin A1c (HbA1c) lowers insulin level requirements and increases the frequency of self-reported severe hypoglycaemic episodes. In recent years, an increase in body weight has been observed after introducing a gluten-free diet in patients with coeliac disease. Furthermore, ready-to-eat gluten-free products, most often chosen by patients, are characterized by a low nutritional value and a high glycaemic index. A review of recent literature showed that after introducing the gluten-free diet (GFD) in this group of patients, an increase in body mass was observed. It is highlighted that the early diagnosis of CD among patients with T1DM and initiation of a GFD under regular dietetic supervision may prevent further deterioration in the nutritional status of patients, and may also reduce the prospect of CD complications without having any evident impact on T1DM control. It seems that nutritional education among these patients is important.
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