Celiac Disease and Diabetes: when to test and Treat.

Prevalence studies from around the world have established a substantial increase in the prevalence of celiac disease (CD) in patients with type 1 diabetes (T1DM). About two-thirds of patients with T1DM and CD are asymptomatic for CD at diagnosis. We aim to provide an up-to-date state of the art summary of the recommendations for serologic testing for CD in patients with T1DM, and to clarify the debate on the need for screening and interventions. We searched Medline, and Cochrane databases for studies of celiac autoimmunity and biopsy-proven CD in people with T1DM between January 1 2000 and December 1, 2015. CD was found to be an independent risk factor for microvascular and macrovascular complications, as well as for increased morbidity in patients with T1DM. However, publications reveal controversy regarding the benefits of a gluten free diet (GFD) on glycemic control, bone health and quality of life in individuals with T1DM and asymptomatic CD. A multicenter, prospective randomized controlled trial aimed to investigate this issue is currently ongoing. Until resolution of the pros and cons of screening for CD, and of the benefit versus burden of GFD treatment in T1DM patients with asymptomatic CD, we recommend repeated screening for CD during childhood and adulthood, and treatment with GFD for those with biopsy-proven CD, even if asymptomatic. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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