Associated conditions
- There is an increased prevalence of coeliac disease in people with Type 1 diabetes and people with autoimmune thyroid disease. People with these conditions should be tested for coeliac disease.
- Down's syndrome and Turner syndrome are associated with an increased risk of coeliac disease and testing for coeliac disease should be considered in people with these conditions.
Type 1 diabetes
People with Type 1 diabetes are at a higher risk than the general population of having coeliac disease. Between 4 and 9% of people with Type 1 diabetes also have coeliac disease compared with 1% of the general population. The NICE guideline recommends that people with Type 1 diabetes should be screened for coeliac disease at diagnosis.
The association is probably because both diseases have a common genetic predisposition. HLA-DQB1 is the gene present in the majority of people with both conditions. There is no increased risk of coeliac disease in people with Type 2 diabetes.
Coeliac disease can develop at any age, therefore NICE recommends that healthcare professionals should have a low threshold for retesting people for coeliac disease if they develop symptoms consistent with coeliac disease.
For patients diagnosed with both diabetes and coeliac disease, blood glucose levels should be monitored closely following coeliac disease diagnosis as insulin levels often need to be altered due to the increased absorption of carbohydrate. Gluten free alternatives to wheat containing bread, pasta, biscuits and flour have approximately the same carbohydrate content as their gluten containing counterparts, and therefore should not necessarily compromise the diet.
Dietary management of the combined diseases requires professional guidance from a dietitian. The aim of dietary management is to improve blood glucose control as well as support people with advice on the gluten free diet. Children with coeliac disease and Type 1 diabetes should have their growth and development carefully monitored.
Dr Matt Kurien spoke about coeliac disease and Type 1 diabetes at our Research Conference in 2017.
Autoimmune thyroid disease
People with autoimmune thyroid disease have an increased prevalence of coeliac disease (1 - 4% compared with 1% in the general population). Patients often gain weight once they have started a gluten free diet. If your patients have unexplained weight gain following diagnosis with coeliac disease, and this does not level out, it would be beneficial to test for this condition.
Autoimmune liver disease
Abnormal liver biochemistry is common in untreated and undiagnosed coeliac disease. NICE recommends ‘those with persistently raised liver enzymes with unknown cause should be considered for testing for coeliac disease. If concerns are raised in the annual review, the healthcare professional should assess the need for specific blood tests. If liver function tests were high at diagnosis and there are ongoing concerns, further testing may be required.