Effect of celiac disease on glycemic control among subjects with autoimmune insulin-dependent diabetes
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Purpose: The aim of this study was to determine whether glycemic control is different between subjects who screened negative for Celiac Disease (CD) compared to subjects who screened positive for CD among subjects with autoimmune insulin-dependent diabetes. Also, this study investigated if the presence of specific beta cell autoantibodies, GAD65, Islet cell antibodies or both, could predict the risk for positive CD screening. METHODS/PROCEDURES: A retrospective cohort study of an existing clinical care data was obtained from the Clinical Data Warehouse (CDW) in Boston Medical Center (BMC) for the period between January 2000 and November 2015. The exposed cohort included those who screened positive for CD, while the non-exposed cohort included subjects who screened negative for CD. The following data was collected and included in the analysis: demographic variables, A1C levels, Diabetic Ketoacidosis (DKA) events, diabetes-associated antibodies, CD screening tests, and CD biopsy results. Longitudinal data for each subject was obtained from the CDW. RESULTS: The prevalence of potential CD in this study was 8.8%, while the prevalence of biopsy confirmed CD was 4.4%. Mean A1C level for subjects who screened negative for TTG was 8.9% (CI 8.3 - 9.6), while mean A1C levels for subjects who screened positive for TTG was 7.9% (CI 6.8 - 9.0) after adjusting for confounders using the mixed-effect model. This difference was not statistically significant. Moreover, diabetes-associated antibodies did not predict the risk for positive TTG screening. CONCLUSION: The glycemic control for subjects who screened negative for CD was found to be similar to subjects who screened positive for CD. However, further studies with higher power and larger sample size are needed to confirm the findings of this study.