Abstract
Many reports indicate a hypercoagulative state in diabetes mellitus as result of endothelial damage. Experimental evidence suggests that a metabolic derangement triggers a cascade of biochemical events that lead to vascular dysfunction. The net effect is to convert the endothelium from thromboresistant to thrombogenic surface. In literature, a strong association between type 1 diabetes mellitus (DM1) and celiac disease (CD) has been reported. We do not have information about the hemostatic system in these associated conditions. Our study aims at evaluating whether the presence of CD in a group of DM1 patients is associated with a different expression of some hemostatic factors and with a different manifestation and/or progression of microvascular complications of DM1 in comparison with patients with only diabetes. Ninety-four adult DM1 patients were enrolled in the study and subsequently screened for CD. Anti-endomysial antibodies (EMA) were positive in 13 of 94 DM1 patients (13.8%). CD diagnosis was confirmed by histology and organ culture. The mean age and duration of DM1 of patients also affected by CD were similar to those of only diabetic patients, but the metabolic control and the hemocoagulative parameters were significantly different between the two groups: DM1 patients also affected by CD presented significantly lower concentrations of glycosylated hemoglobin (HbA1c) (P < 0.05), cholesterol (P < 0.001), triglycerides (P < 0.001), factor VII antigen (FVII:ag) (P < 0.005), factor VII coagulant activity (FVII:c) (P < 0.05), and prothrombin degradation fragments (F1+2) (P < 0.001), as well as higher values of activated C protein (APC) (<0.001). No retinal abnormalities and no signs of renal damage were observed in DM1 patients also affected by CD. Our results suggest a potential protective role of CD in the prothrombotic state of DM1.
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References
Rubio-Tapia A, Murray JA (2010) Celiac disease. Curr Opin Gastroenterol 26:116–122
Barker JM, Liu E (2008) Celiac disease: pathophysiology, clinical manifestations, and associated autoimmune conditions. Adv Pediatr 55:349–365
Savilati E, Simell O, Koskimies S, Rilva A, Akerblom H (1986) Celiac disease in insulin-dependent diabetes mellitus. J Pediatr 108:690–693
Cronin CC, Feighery A, Ferris JB, Liddy C, Shanahan F, Feighery C (1997) High prevalence of celiac disease among patient with insulin-dependent (type 1) diabetes mellitus. Am J Gastroenterol 92:2210–2212
Kahaly GJ (2009) Polyglandular autoimmune syndromes. Eur J Endocrinol 161:11–20
Barera G, Bonfanti R, Viscardi M, Bazzigaluppi E, Calori G, Meschi F, Bianchi C, Chiumello G (2002) Occurrence of celiac disease after onset of type 1 diabetes: a 6-year prospective longitudinal study. Pediatrics 109:833–838
Galicka-Latała D, Zwolińska-Wcisło M, Sosin-Rudnicka L, Rozpondek P (2009) The role of celiac disease and type 1 diabetes coexistence. Is celiac disease responsible for diabetic status? Przegl Lek 66:170–175
Picarelli A, Sabbatella L, Di Tola M, Vetrano S, Casale C, Anania MC, Porowska B, Vergari M, Schiaffini R, Gargiulo P (2005) Anti-endomysial antibody of IgG1 isotype detection strongly increases the prevalence of celiac disease in patients affected by type 1 diabetes mellitus. Clinic Exp Immunol 142:111–115
Vicuña AM, Zozaya UJM, Martínez de EJP, Carral MD, Pineda AJ, Forga LL, Martínez-Peñuela VJM, Rodríguez GC, Menéndez TE, Jiménez PFJ, Layana EE (2010) Study of celiac disease in adults with type 1 diabetes mellitus. Gastroenterol Hepatol 33:6–11
Fidan E, Onder Ersoz H, Yilmaz M, Yilmaz H, Kocak M, Karahan C, Erem C (2011) The effects of rosiglitazone and metformin on inflammation and endothelial dysfunction in patients with type 2 diabetes mellitus. Acta Diabetol [Epub ahead of print]
Kubisz P, Chudý P, Stasko J, Galajda P, Hollý P, Vysehradský R, Mokán M (2010) Circulating vascular endothelial growth factor in the normo- and/or microalbuminuric patients with type 2 diabetes mellitus. Acta Diabetol 47(2):119–124
Ceriello A (1993) Coagulation activation in diabetes mellitus: the role of hyperglycemia and therapeutic prospects. Diabetologia 36:1119–1125
Kirpichnikov D, Sowers JR (2001) Diabetes mellitus and diabetes-associated vascular disease. Trends Endocrinol Metab 12:225–230
Ford I, Singh TP, Kitchen S, Makris M, Ward JD, Preston FE (1991) Activation of coagulation in diabetes mellitus in relation to the presence of vascular complications. Diabetic Med 8:322–329
Knöbl P, Schernthaner G, Schnack C, Pietschmann P, Proidl S, Prager R, Vukovich T (1994) Haemostatic abnormalities persist despite glycaemic improvement by insulin therapy in lean type 2 diabetic patients. Thromb Haemost 71:692–697
Grant PJ (1998) Metformin reduces circulating factor VII concentrations in patients with type 2 diabetes mellitus. Thromb Haemost 80:209–210
Grant PJ (2007) Diabetes mellitus as a prothrombotic condition. J Intern Med 262:157–172
Rodesch P, Cadranel S, Winckler M, Loeb H (1976) Hypovitaminosis K in celiac disease. Acta Paediatr Belg 29:123–124
American Diabetes Association (2010) Standards of medical care in diabetes. Diabetes Care 33:S11–S61
Mogensen CE, Schmitz O (1988) The diabetic kidney: from hyperfiltration and microalbuminuria to end-stage renal failure. Med Clin North Am 72:1465–1492
Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT (2003) Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 110:1677–1682
Fasano A, Araya M, Bhatnagar S, Cameron D, Catassi C, Dirks M, Mearin ML, Ortigosa L, Phillips A (2008) Federation of international societies of pediatric gastroenterology, hepatology, and nutrition consensus report on celiac disease. J Pediatr Gastroenterol Nutr 47:214–219
Picarelli A, Sabbatella L, Di Tola M, Vetrano S, Maffia C, Picchi C, Mastracchio A, Paoluzi P, Anania MC (2001) Forty-eight hours of biopsy culture improve the sensitivity of the in vitro gliadin challenge in the diagnosis of celiac disease. Clin Chem 47:1841–1843
Picarelli A, Di Tola M, Sabbatella L, Anania MC, Calabrò A, Renzi D, Bai JC, Sugai E, Carroccio A, Di Prima L, Bardella MT, Barisani D, Ribes-Koninckx C, Aliaga ED, Gasparin M, Bravi E, Multicentre Organ Culture System Study Group (2006) Usefulness of the organ culture system in the in vitro diagnosis of celiac disease: a multicentre study. Scand J Gastroenterol 41:186–190
Santaolalla R, Fernández-Bañares F, Rodríguez R, Alsina M, Rosinach M, Mariné M, Farré C, Salas A, Forné M, Loras C, Espinós J, Viver JM, Esteve M (2008) Diagnostic value of duodenal anti-tissue transglutaminase antibodies in gluten-sensitive enteropathy. Aliment Pharmacol Ther 27:820–829
Marsh MN, Crowe PT (1995) Morphology of the mucosal lesion in gluten sensitivity. Ballieres Clin Gastroenterol 9:273–293
Oberhuber G, Granditsch G, Vogelsang H (1999) The histopathology of celiac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 11:1185–1194
Boyer C, Wolf M, Rothschild C, Migaud M, Amiral J, Mannucci PM, Meyer D, Larrieu MJ (1986) An enzyme immunoassay (ELISA) for the quantification for human factor VII. Thromb Haemost 56:250–255
Poggio M (1990) Specific assays of haemostasis proteins: factor VII. Ric Clin Lab 20:139–141
Tietel M, Bauer KA, Lau HK, Rosenberg RD (1992) Studies on the prothrombin activation pathway utilising radioimmunoassay for the F2/F1+2 fragment and thrombin-antithrombin complex. Blood 59:1086–1097
Pocecco M, Ventura A (1995) Celiac disease and insulin dependent diabetes mellitus—a causal association? Acta Pediatr 84:1432–1433
King AL, Moodie SJ, Fraser JS, Curtis D, Reid E, Dearlove AM, Ciclitira PJ (2003) Celiac disease: investigation of proposed causal variants in the CTLA4 gene region. Eur J Immunogenet 30:427–432
Lavant EH, Carlson JA (2009) A new automated human leukocyte antigen genotyping strategy to identify DR-DQ risk alleles for celiac disease and type 1 diabetes mellitus. Clin Chem Lab Med 47:1489–1495
Harding SA, Sommerfield AJ, Sarma J, Twomey PJ, Newby DE, Frier BM, Fox KA (2004) Increased CD40 ligand and platelet-monocyte aggregates in patients with type 1 diabetes mellitus. Atherosclerosis 176:321–325
Lorenzi M, Cagliero E (1991) Pathobiology of endothelial and other vascular cells in diabetes mellitus. Call for data. Diabetes 40:653–659
Cagliero E, Roth T, Roy S, Lorenzi M (1991) Characteristics and mechanisms of high-glucose-induced overexpression of basement membrane components in cultured human endothelial cells. Diabetes 40:102–110
Janka HU, Warram JH, Rand LI, Krolewski AS (1989) Risk factors for progression of background retinopathy in long-standing IDDM. Diabetes 38:460–464
Gargiulo P, Ciampalini P, Bosco D et al (1993) Unmodulated hemostasis in type I diabetics with proliferative retinopathy. In: Joslin-Harvard Symposium on Vascular Complications of Diabetes Mellitus. Boston, MA, October 6–9
Kaspers S, Kordonouri O, Schober E, Grabert M, Hauffa BP, Holl RW, German Working Group for Pediatric Diabetology (2004) Anthropometry, metabolic control, and thyroid autoimmunity in type 1 diabetes with celiac disease: a multicenter survey. J Pediatr 145:790–795
Malalasekera V, Cameron F, Grixti E, Thomas MC (2009) Potential reno-protective effects of a gluten-free diet in type 1 diabetes. Diabetologia 52:798–800
Cordovado SK, Zhao Y, Warram JH, Gong H, Anderson KL, Hendrix MM, Hancock LN, Cleary PA, Mueller PW (2008) Nephropathy in type 1 diabetes is diminished in carriers of HLA-DRB1*04: the genetics of kidneys in diabetes (GoKinD) study. Diabetes 57:518–522
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Picarelli, A., Di Tola, M., Sabbatella, L. et al. Type 1 diabetes mellitus and celiac disease: endothelial dysfunction. Acta Diabetol 50, 497–503 (2013). https://doi.org/10.1007/s00592-011-0301-1
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DOI: https://doi.org/10.1007/s00592-011-0301-1