Coeliac disease is more common in people who have Type 1 diabetes mellitus (DM) because of their autoimmune co-existence. Between 4 and 9% of people with Type 1 DM will also have coeliac disease. The updated NICE guideline (NG 20 coeliac screening) recommends that adult with Type 1 DM should be tested for coeliac disease at diagnosis and retested if any symptoms of coeliac disease develop.
Study method & Result: Newly diagnosed type 1 DM from January 2012 till January 2017 were included. Total number of patients was 36 in 5 years period. Five patients had a coeliac screening (tTG) done at the time of DM diagnosis (14%). 9/36 (25%) patients had the test done anytime during follow ups. One patient had coeliac status retested, unfortunately no clinical indication noted for the rescreening.
We did a similar audit 5 months later, after our DE departmental educational meeting. There was a significant improvement in our results. About 70 % of patient has had their coeliac screening tests done at the time of type 1 DM diagnosis. 2 /10 (20%) had a positive test result, referred to gastroenterology for tissue diagnosis.
Conclusion: For most people, Type 1DM is diagnosed before coeliac disease, although it can happen the other way around. Some people with Type 1 DM appear to have mild or no obvious symptoms of coeliac disease, but their intestinal mucosa will still be damaged when they eat gluten. When coeliac disease is diagnosed before diabetes, the symptoms of diabetes tend to be more severe and there is a higher likelihood of other autoimmune diseases. Recurrent hypoglycaemia can be a sign of coeliac disease in people with Type 1 diabetes. In adults with type 1 diabetes, NG17 recommends assessment of markers for coeliac disease for patiens with low BMI or unexplained weight loss.We conclude from our study that we need to improve coeliac screening for all newly diagnosed type 1 DM as per current NICE recommendation.