Diabetes mellitus Typ 1 und Zöliakie

Zusammenfassung

Die Prävalenz der Zöliakie ist bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1 höher als in der Normalbevölkerung. Meistens liegt eine atypische oder silente Form der Zöliakie vor. Die beiden Erkrankungen sind assoziiert, es sind Autoimmunerkrankungen mit einem gemeinsamen genetischen Hintergrund. Weiters nehmen die Prävalenz der Zöliakie sowie die Inzidenz des Diabetes mellitus Typ 1 laufend zu. Die meisten diabetischen Patienten mit Zöliakie werden erst durch ein gezieltes Screening mittels Antikörper entdeckt und es sind eher jüngere Patienten betroffen. Der Goldstandard der Zöliakie-Therapie ist nach wie vor eine lebenslange glutenfreie Diät. Widersprüchliche Ansichten bestehen über den klinischen Benefit einer frühzeitigen Diagnose der silenten Zöliakie durch Screening von Patienten mit Diabetes mellitus Typ 1 und frühzeitiger Therapie mit einer glutenfreien Diät bei diesen Patienten.

Eine klare Aussage, ob die glutenfreie Diät in diesen Fällen einen Einfluss auf die Längen- und Gewichtsentwicklung bzw. die metabolische Kontrolle hat, ist derzeit noch unklar.

Summary

Celiac disease is more prevalent in individuals with diabetes mellitus type 1 than in the normal population. It often presents in an atypical or silent form. Both diseases are associated; both are autoimmune disorders with a common genetic background. The prevalence of celiac disease is constantly increasing, as well as the incidence of diabetes mellitus type 1. Most of the diabetic patients with celiac disease are diagnosed via antibody-specific screening methods and mostly younger patients are affected. The gold standard of celiac therapy is a gluten free diet. Controversy exists concerning the benefit of an early diagnosis of silent forms of celiac disease via screening of diabetic patients and early therapy with gluten free diet in these patients. A clear answer, whether a gluten free diet in these cases has an influence on growth- and weight-development, or their metabolic control, is still missing.

Schlüsselwörter

Diabetes mellitus Typ 1 - Zöliakie - glutenfreie Diät - Autoimmunerkrankung - Screening

Keywords

Diabetes mellitus type 1 - celiac disease - autoimmune disease - gluten free diet - screening

• Literatur

• 1 Acerini CL. et al. Coeliac disease in children and adolescents with IDDM: clinical characteristics and response to gluten-free diet. Diabet Med 1998; 15 (01) 38-44.
• 2 Anderson RP. et al. In vivo antigen challenge in celiac disease identifies a single transglutaminasemodified peptide as the dominant A-gliadin T-cell epitope. Nat Med 2000; 6 (03) 337-42.
• 3 Barera G. et al. Occurrence of celiac disease after onset of type 1 diabetes: a 6-year prospective longitudinal study. Pediatrics 2002; 109 (05) 833-8.
• 4 Burgin-Wolff A. et al. Antigliadin and anti-endomysium antibody determination for coeliac disease. Arch Dis Child 1991; 66 (08) 941-7.
• 5 Carlsson AK. et al. Prevalence of IgA-anti-endomysium and IgA-antigliadin autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children and adolescents. Pediatrics 1999; 103 (06) (Suppl. 01) 1248-52.
• 6 Carlsson AK. et al. Serological screening for celiac disease in healthy 2.5-year-old children in Sweden. Pediatrics 2001; 107 (01) 42-5.
• 7 Catassi C, Fabiani E. The spectrum of coeliac disease in children. Baillieres Clin Gastroenterol 1997; 11 (03) 485-507.
• 8 Catassi C. et al. Italian Working Group on Coeliac Disease and Non-Hodgkin’s-Lymphoma. Risk of non-Hodgkin lymphoma in celiac disease. JAMA 2002; 287 (11) 1413-9.
• 9 Cerutti F. et al. Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology. Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes: an Italian multicenter study. Diabetes Care 2004; 27 (06) 1294-8.
• 10 Crone J, Rami B, Huber WD, Granditsch G, Schober E. Prevalence of celiac disease and follow-up of EMA in children and adolescents with type 1 diabetes mellitus. J Pediatr Gastroenterol Nutr 2003; 37 (01) 67-71.
• 11 Cronin CC, Shanahan F. Exploring the iceberg – the spectrum of celiac disease. Am J Gastroenterol 2003; 98 (03) 518-20.
• 12 Danne T, Beyer R, Holl RW, Kiess W, Kordonouri O, Lange K, Lepler R, Marg W, Neu A, Petersen M, Ziegler A. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. Diabetes und Stoffwechsel 2004; 13 (Suppl. 02) 57-69.
• 13 Dieterich W. et al. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med 1997; 3 (07) 797-801.
• 14 Dieterich W. et al. Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 1998; 115 (06) 1317-21.
• 15 Edlinger-Horvat C, Fidler D, Huber WD, Rami B. et al. Serological screening for undiagnosed coeliac disease in male adolescents in lower Austria: a population based study. Eur J Pediatr 2005; 164 (01) 52-3.
• 16 Fabiani E. et al. Compliance with gluten-free diet in adolescents with screening-detected celiac disease: a 5-year follow-up study. J Pediatr 2000; 136 (06) 841-3.
• 17 Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 2001; 120 (03) 636-51 Review.
• 18 Gasbarrini A. et al. Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. Lancet 2000; 29: 356 (9227): 399–400.
• 19 Green A, Patterson CC. EURODIAB TIGER Study Group. Europe and Diabetes. Trends in the incidence of childhood-onset diabetes in Europe 1989–1998. Diabetologia 2001; 3 (Suppl. 44) B3-8.
• 20 Hadjivassiliou M. et al. Does cryptic gluten sensitivity play a part in neurological illness?. Lancet 1996; 347 (8998): 369-71.
• 21 Hansen D. et al. High prevalence of coeliac disease in Danish children with type I diabetes mellitus. Acta Paediatr 2001; 90 (11) 1238-43.
• 22 Holmes GK. Coeliac disease and Type 1 diabetes mellitus – the case for screening. Diabet Med 2001; 18 (03) 169-77.
• 23 Holmes GK. Screening for coeliac disease in type 1 diabetes. Arch Dis Child 2002; 87 (06) 495-8.
• 24 International Society for Pediatric and Adolescent Diabetes, International Diabetes Federation World Health Organisation. Consensus guidelines for the management of insulin-dependent (type 1) diabetes mellitus in childhood and adolescence. Ed. PGF Swift. Zeist, Niederlande: Publ Medforum; 2000. www.ispad.org
• 25 Kaspers S. et al. German Working Group for Pediatric Diabetology. Anthropometry, metabolic control, and thyroid autoimmunity in type 1 diabetes with celiac disease: a multicenter survey. J Pediatr 2004; 145 (06) 790-5.
• 26 Kordonouri O. et al. Autoantibodies to tissue transglutaminase are sensitive serological parameters for detecting silent coeliac disease in patients with Type 1 diabetes mellitus. Diabet Med 2000; 17 (06) 441-4.
• 27 Logan RF. et al. Changes in clinical features of coeliac disease in adults in Edinburgh and the Lothians 1960–79. Br Med J (Clin Res Ed) 1983; 286 (6359): 95-7.
• 28 Lorini R. et al. Clinical aspects of coeliac disease in children with insulin-dependent diabetes mellitus. J Pediatr Endocrinol Metab 1996; 1 (Suppl. 09) 101-11.
• 29 Maki M. et al. Prevalence of celiac disease among children in Finland. New Eng J Med 2003; 348: 2517-24.
• 30 Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992; 102 (01) 330-54.
• 31 Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol 1995; 9 (02) 273-93.
• 32 Mohn A. et al. Celiac disease in children and adolescents with type I diabetes: importance of hypoglycemia. J Pediatr Gastroenterol Nutr 2001; 32 (01) 37-40.
• 33 Mora S. et al. Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients. Am J Gastroenterol 1999; 94 (02) 398-403.
• 34 Roldan MB. et al. Diagnostic value of serological markers for celiac disease in diabetic children and adolescents. J Pediatr Endocrinol Metab 1998; 11 (06) 751-6.
• 35 Saukkonen T. et al. Coeliac disease: frequent occurrence after clinical onset of insulin-dependent diabetes mellitus. Childhood Diabetes in Finland Study Group. Diabet Med 1996; 13 (05) 464-70.
• 36 Schober E. et al. Screening by anti-endomysium antibody for celiac disease in diabetic children and adolescents in Austria. J Pediatr Gastroenterol Nutr 2000; 30 (04) 391-6.
• 37 Shan L. et al. Structural basis for gluten intolerance in celiac sprue. Science 2002; 297 (5590): 2275-9.
• 38 Shan L, Mathews II, Khosla C. Structural and mechanistic analysis of two prolyl endopeptidases: role of interdomain dynamics in catalysis and specificity. Proc Natl Acad Sci USA 2005; 102 (10) 3599-604.
• 39 Sollid LM, Thorsby E. HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis. Gastroenterology 1993; 105 (03) 910-22.
• 40 Stern M. et al. Analysis and clinical effects of gluten in coeliac disease. Eur J Gastroenterol Hepatol 2001; 13 (06) 741-7.
• 41 Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology 1999; 117 (02) 297-303.
• 42 Westman E, Ambler GR, Royle M, Peat J, Chan A. Children with coeliac disease and insulin dependent diabetes mellitus – growth, diabetes control and dietary intake. J Pediatr Endocrinol Metab 1999; 12 (03) 433-42.