Association between Diabetes Mellitus type 1 and Celiac Disease: case-control study among Sudanese patients 2009-2011

Ahmed  Bolad; Ahmed  Farouk; Mohamed  Faisal Lutfi; Mustafa  Nemeiri

doi:10.52981/sjms.v7i2.1038

Ahmed Bolad Department of Microbiology and Immunology
Ahmed Farouk Department of Microbiology and Immunology.
Mohamed Faisal Lutfi Department of Physiology
Mustafa Nemeiri Al Neelain University

DOI: https://doi.org/10.52981/sjms.v7i2.1038

Keywords: Diabetes mellitus type I, Celiac disease and diabetes mellitus type I association, IgG anti-tissue transglutaminase antibodies;, IgA anti-endomysial antibodies

Abstract

Background: Gluten sensitive enteropathy (celiac disease (CD)) has a strong association with
diabetes mellitus (type 1DM). Since, 2-3% of CD patients have selective IgA deficiency, the
majority of the available tests may fail to show the auto-antibodies (the IgA endomysial antibody
(EMA). To prevent such a false negativity, a new Enzyme Linked Immune Sorbent Assay (ELISA)
test has been introduced to detect both IgG and IgA antibodies reactive with tissue transglutaminase
(tTG), an autoantigen in CD patients.
Objectives: This study has been conducted to detect celiac disease among Sudanese patients with
type 1 autoimmune diabetes using anti-tissue transglutinamase antibodies as a diagnostic tool.
Patients and Methods: Samples were collected from sixty nine randomly selected patients (38
males and 31 females) and their age ranged between 3-22 years with DM type 1 who were attending
the outpatient clinics in Gabir Abu Eliz diabetic Center and Omdurman Pediatric Emergency
Hospital. Blood samples were collected from 25 healthy individuals as controls. Levels of tTG
specific IgA, tTG specific IgG and anti-endomysial antibodies of IgA class were measured in sera
collected from both cases and from controls. All the results were analyzed using Statistical
Packages of Social Sciences (SPSS) version 17 and MicroSoft office excel.
Results: Seven out of 69 patients with DM type 1 (10.1%) were identified as having CD using IgG
anti-tTG and 5 (7.2%) of them were positive for IgA anti-tTG and IgA anti-endomysial antibodies.
The mean of both anti-tTG IgA and IgG titers were higher in diabetic patients (M±SD = 12.30±41.0
and 7.2±13.1 respectively) when compared with the control group (M±SD =1.8±1.1 and 1.8±0.9
respectively), however, only anti-tTG IgG antibodies titer achieved statistical significance.
Discussion and conclusion: The present study revealed that patients with DM type I have an
increased tendency to develop CD. The increased association of CD and selective IgA deficiency is
a potential source of false-negative IgA, therefore testing for IgG class autoantibodies is
recommended if celiac disease is suspected. Antibodies to tTG antigen fall once a gluten-free diet
has begun, thus facilitating monitoring of dietary compliance. Thus, anti-tTG antibodies are highly
sensitive marker for celiac disease with 95- 100 % sensitivty, and specificity of 90 to 97 %.

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