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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
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK; Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK; Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-1024-5602
2015 (English)In: Acta Diabetologica, ISSN 0940-5429, E-ISSN 1432-5233, Vol. 52, no 6, p. 1167-1174Article in journal (Refereed) Published
Abstract [en]

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.

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 a parts per thousand currency sign30 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.

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.

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

Place, publisher, year, edition, pages
Springer Milan, 2015. Vol. 52, no 6, p. 1167-1174
Keywords [en]
Celiac disease, Coma (diabetic), Diabetic ketoacidosis, Hypoglycemia
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-46830DOI: 10.1007/s00592-015-0808-yISI: 000363950500018PubMedID: 26403595Scopus ID: 2-s2.0-84945466377OAI: oai:DiVA.org:oru-46830DiVA, id: diva2:874568
Funder
Swedish Research Council
Note

Funding Agencies:

Swedish Society of Medicine

Swedish Celiac Society

Available from: 2015-11-27 Created: 2015-11-27 Last updated: 2018-07-02Bibliographically approved

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Ludvigsson, Jonas F.

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