TYPE 1 DIABETES MELLITUS AS AN EXTRA INTESTINAL MANIFESTATION OF CELIAC DISEASE: THE IMPORTANCE OF SCREENING AND EARLY TREATMENT

• DOI: 10.22533/at.ed.1593682301091

• Palavras-chave: “Celiac disease"; “HLA antigens”; “Diabetes Mellitus Type 1”.

• Keywords: “Celiac disease"; “HLA antigens”; “Diabetes Mellitus Type 1”.

• Abstract:

  Introduction: Celiac disease (CD) is an autoimmune disease that has a specific serological and histological profile that occurs after gluten ingestion by genetically predisposed patients. The disease has a wide spectrum of symptoms and multifactorial causes. In addition, the disease is characterized by being difficult to diagnose, in part due to the wide range of clinical manifestations that can misdirect and prevent diagnosis. Type 1 Diabetes Mellitus (DM1) is a chronic autoimmune disease that leads to complete or partial destruction of pancreatic beta cells, thus resulting in a progressive inability to produce insulin. DM1 causes several lesions in different organs, due to micro and macrovascular alterations, which generate dysfunctions and insufficiencies in the body. It is known that there is an intimate relationship between these two pathologies, the prevalence of CD among patients with DM1 has been estimated at approximately 4.0%. This association between the two pathologies occurs due to the presence of the human histocompatibility antigen (HLA) DQ, encoded by the DQ2 and DQ8 genes on chromosome 6, which suggests a genetic cause for the simultaneous occurrence of the two diseases, since such genes are shared by DM1, CD and other autoimmune diseases. Goal: To carry out an integrative literature review to seek to understand the relationship between celiac disease and type 1 diabetes, as well as the pathophysiology and immunopathogenesis involved in the association between these two pathologies. Method: PubMed, SciELO, and LILACS databases were methodically searched from 2000 to 2021 to identify all studies that evaluated the relationship between celiac disease and type 1 diabetes. Results: According to the studies analyzed, celiac disease was associated with a statistically significant increase in the risk of subsequent type 1 diabetes before age 20. In addition, prevalence of biopsy-confirmed celiac disease was also found in about 6% of the population with T1DM. In this study, the prevalence was lower in adults with type 1 diabetes (2.7%) and in mixed populations with children and adults with type 1 diabetes (4.7%) than in children (6.2%) with type 1 diabetes. 1.
  The correlation between the prevalence of patients with Type I Diabetes Mellitus and Celiac Disease is notorious, and CD often manifests itself asymptomatically, which may worsen the clinical picture regarding DM1. Diagnosis and adequate treatment of CD are essential for the reduction of possible complications and risks resulting from diabetes to be possible, promoting an improvement in the quality of life of patients with both comorbidities. Celiac Disease may be responsible for accelerating the worsening of Type I Diabetes Mellitus, with the onset of chronic complications of DM1 prematurely. An example of a complication is Diabetic Nephropathy (DN), which appears earlier in patients with CD at the same time, since the role of the disease in the development of chronic hyperglycemia is suspected, which, in addition to culminating in a thickening of the glomerular basement membranes, in the kidneys, also has other repercussions in different body systems, as in the case of Diabetic Nephropathy. In addition, the state of hyperglycemia generated in the body is a triggering factor for Peripheral Neuropathy, a condition characterized by a change in the conduction of nerve impulses, due to the excessive entry of glucose into the cells of the neuronal and endothelial tissues. The association between both diseases is also responsible for causing a greater cardiovascular risk for the patient, since it was identified that individuals with both diseases have lower levels of HDL-cholesterol, associated with possible more severe conditions of atherosclerosis, in due to a greater thickening of the intima-media layer
  . Conclusion: In many cases, celiac disease symptoms go undiagnosed, as most individuals assume they are just symptoms of diabetes. Therefore, for a better control of type 1 diabetes mellitus to be carried out, it is imperative that the underlying cause of any symptom experienced by the patient be discovered. People who have DM1 and CD concomitantly have difficult diabetes control. The complexity of treating T1DM in patients with celiac disease is due to the fact that gluten in food causes inflammation in the intestine, which changes the way food is absorbed. This causes blood sugar fluctuations to be carried out more frequently and also with greater intensity. Thus, for individuals who have both autoimmune diseases, it is critical that a strict diet be followed to reduce the risk of diabetes and untreated celiac disease.