Are pediatric celiac disease and type 1 diabetes related?

The link between type 1 diabetes mellitus and celiac disease — both autoimmune diseases — was first established in the 1960s. The estimated prevalence of celiac disease in patients with type 1 diabetes is approximately 6%, and about 1% in the general population. Pediatric gastroenterologist Ritu Verma, MD and adult and pediatric endocrinologist Katie O’Sullivan, MD discuss approaches to co-managing celiac disease and diabetes.

What are symptoms of celiac disease in children?

The symptoms of celiac disease can vary from child to child and can depend on the age of onset. Gastrointestinal symptoms of celiac disease can include, but are not limited to distended belly, diarrhea and constipation. However, a child can present with non-gastrointestinal symptoms such as brain fog, anemia, hair loss, dental enamel defects, pancreatitis, joint pain, delayed puberty and rash.

It is also possible for a child to present with no symptoms at all. For instance, 5-10% of children with type 1 diabetes are diagnosed with celiac disease and the majority of these children do not show symptoms of celiac disease. Whether or not individuals have symptoms, if a celiac disease diagnosis is confirmed, it is absolutely essential to follow a strict gluten-free diet to avoid the same health risks for untreated celiac disease.

Does having both celiac disease and diabetes present unique challenges for treatment?

Yes, because having celiac disease can make diabetes symptoms more difficult to manage. Children with this dual diagnosis may not receive the proper nutrition in order to thrive. First, eating gluten causes inflammation in the gut lining, which affects how the gut absorbs food. Second, gluten-free flour substitutes that typical celiac patients consume tend to be higher in carbohydrate content than their gluten-containing counterparts. The body turns carbohydrates into glucose, making blood sugar levels rise and this is a problem for diabetics.

The treatment approach should be multidisciplinary because it involves the assistance of registered dietitians who can identify foods the family already eats that are gluten-free and have a low glycemic index. This includes foods such as fruits, vegetables, nuts, poultry and fish.

It is important to note that the multidisciplinary team may adjust the amount of insulin a patient gets once the child is diagnosed with celiac disease because, with their gluten-free diet, their bodies can more effectively absorb nutrients.

If a child’s celiac disease is well managed, will their diabetes symptoms decrease or vice versa?

A well-managed celiac disease will not cure the patient’s type 1 diabetes. However, a gluten-free diet may provide benefits for children with diabetes. Absorption of nutrients will improve and they are more likely to maintain a healthy weight while sustaining balanced blood sugars.

Having both celiac disease and type 1 diabetes can cause a lot of stress. What are some tips to help children and families cope with these diagnoses?

Research has shown a higher prevalence of depression in children with type 1 diabetes compared to the general pediatric population. It's even more prevalent in children with type 1 diabetes and celiac disease compared to children who only have type 1 diabetes . This emphasizes the need to assess patients for potential psychological effects that come with the diagnosis of type 1 diabetes.

UChicago Medicine can provide these services for our pediatric patients. To make the child's life easier with diabetes monitoring, we encourage the use of continuous glucose monitors verus fingersticks, and an insulin pump versus insulin shots. Furthermore, we inform our patients and their families of the various support groups for children which give them a place to meet peers with similar conditions.

Why should you consider treatment at a multidisciplinary clinic for type 1 diabetes and celiac disease?

A multidisciplinary clinic can help educate parents and children on both diseases with one appointment. This means patients can obtain vital information and see specialists at a one-stop-shop where children and parents will not have to miss as much school or work. The appointments at UChicago Medicine will include seeing a gastroenterologist, endocrinologist, and our registered dietitian, Macy Mears, MS, RDN, LDN.