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A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

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Abstract

Aims

Celiac disease (CD) may influence metabolic control in type 1 diabetes (T1D). This work examines whether CD in T1D influences hospital admissions due to coma, ketoacidosis and hypoglycemia.

Methods

In population-based cohort study, individuals with CD were identified using biopsy data (1969–2008) from Sweden’s 28 pathology departments. T1D was defined as a recorded diagnosis of T1D at age ≤30 years in the Swedish National Patient Register between 1964 and 2009. In total, 906 individuals had both T1D and CD and were matched for sex, age and calendar period with 4303 reference individuals. Through stratified Cox regression analysis, we modeled CD as a time-dependent covariate and estimated the risk of future coma, ketoacidosis and hypoglycemia, defined by relevant international classification of disease codes among T1D patients with and without CD.

Results

During follow-up, patients with both T1D and CD had 49 hospital admissions with diabetic coma, 91 episodes of ketoacidosis and 25 hypoglycemic events. Among patients with T1D, CD did not influence the risk of coma (adjusted HR 0.97; 95 % CI 0.72–1.32), ketoacidosis (adjusted HR 1.08; 95 % CI 0.86–1.34), or hypoglycemia (adjusted HR 1.34; 95 % CI 0.87–2.05). The absolute risk of coma was 621/100,000 person-years in T1D and CD (637 in controls). Corresponding figures for ketoacidosis were 1175/100,000 person-years in T1D and CD (1092 in controls) and for hypoglycemia 316/100,000 person-years (236 in controls). HRs for metabolic emergencies in T1D were similar in the first 5 years after T1D diagnosis as thereafter.

Conclusions

Having a diagnosis of CD is unlikely to influence the risk of coma, ketoacidosis and hypoglycemia in T1D patients.

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Abbreviations

CD:

Celiac disease

CI:

Confidence interval

HR:

Hazard ratio

ICD:

International classification of disease (codes)

OR:

Odds ratio

VA:

Villous atrophy

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Acknowledgments

Funding

JFL was supported by Grants from the Swedish Society of Medicine, the Swedish Research Council and the Swedish Celiac Society. MK, DSS and KM have no funding declarations in relation to this work. None of the funders had any influence on this study.

Contribution statement

All authors made substantial contributions to the study’s conception and design, acquisition of data and analysis and interpretation of data. All authors were involved in drafting of this article and revising it critically for important intellectual content and gave final approval of the version to be published. J.F.L is the guarantor for this work.

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Authors and Affiliations

  1. Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK

    Matthew Kurien & David S. Sanders

  2. Academic Unit of Gastroenterology, University of Sheffield, Sheffield, S10 2RX, UK

    Matthew Kurien & David S. Sanders

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden

    Kaziwe Mollazadegan & Jonas F. Ludvigsson

  4. Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden

    Jonas F. Ludvigsson

Authors
  1. Matthew Kurien
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  2. Kaziwe Mollazadegan
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  3. David S. Sanders
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  4. Jonas F. Ludvigsson
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Corresponding author

Correspondence to Jonas F. Ludvigsson.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was performed according to the criteria of the Helsinki II Declaration and was approved by the local Ethics Review board.

Human and animal rights disclosure

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, revised in 2008.

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

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Kurien, M., Mollazadegan, K., Sanders, D.S. et al. A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes. Acta Diabetol 52, 1167–1174 (2015). https://doi.org/10.1007/s00592-015-0808-y

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