A population-based study of the risk of diabetic retinopathy in patients with type 1 diabetes and celiac disease
Open accessAbstract
OBJECTIVE: Celiac disease (CD) is associated with type 1 diabetes (T1D). In the current study, we examined whether CD affects the risk of diabetic retinopathy (DRP) in patients with T1D. RESEARCH DESIGN AND METHODS: This was a population-based cohort study. Through the Swedish National Patient Register, we identified 41,566 patients diagnosed with diabetes in 1964–2009 and who were ≤30 years of age at diagnosis. CD was defined as having villous atrophy (Marsh stage 3) according to small intestinal biopsies performed between 1969 and 2008, with biopsy reports obtained from Sweden’s 28 pathology departments. During follow-up, 947 T1D patients had a diagnosis of CD. We used Cox regression analysis with CD as a time-dependent covariate to estimate adjusted hazard ratios (aHRs) for DRP in patients with T1D and CD and compared them with patients with T1D but no CD. RESULTS: Duration of CD correlated with the risk of DRP. When results were stratified by time since CD diagnosis, individuals with T1D and CD were at a lower risk of DRP in the first 5 years after CD diagnosis (aHR 0.57 [95% CI 0.36–0.91]), followed by a neutral risk in years 5 to <10 (1.03 [0.68–1.57]). With longer follow-up, coexisting CD was a risk factor for DRP (10 to <15 years of follow-up, aHR 2.83 [95% CI 1.95–4.11]; ≥15 years of follow-up, 3.01 [1.43–6.32]). CONCLUSIONS: Having a diagnosis of CD for >10 years is a risk factor for the development of DRP in T1D. Long-standing CD in patients with T1D merits intense monitoring of DRP.
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Patients with both celiac disease and type 1 diabetes have an increased risk of diabetic retinopathy compared to isolated type 1 diabetes.
“and of diabetic retinopathy compared to isolated T1D (123).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [123]
The Abstract Results report increased retinopathy risk for patients with both conditions only after at least 10 years following celiac disease diagnosis. They report lower risk during the first five years and no clear difference from five to under ten years, so the unqualified claim overstates the finding. Page numbers were not supplied. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the age range up to 18 years, ICD-8 and ICD-9 diabetes codes identify type 1 diabetes with high positive predictive value because type 2 diabetes is infrequent in the Swedish population.
“ICD-8 and -9 do not distinguish between type 1 and type 2 diabetes, but in our age range (≤18 years) these codes identify type 1 diabetes with high positive predictive value, as type 2 diabetes is rather infrequent in the Swedish population up to 18 years of age (17).”
From Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a population-based cohort study (2015) · cites this paper as [17]
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References 34 · Cited by 82
- Authors
- Mollazadegan, K., Kugelberg, M., Montgomery, S. M., Sanders, D. S., Ludvigsson, J., & Ludvigsson, J. F.
- Affiliations
- Karolinska Institutet (SE)
- Royal Hallamshire Hospital (GB)
- Linköping University (SE)
- Corresponding author
- Mollazadegan, Kaziwe
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2013-01-17
- Volume
- 36
- Issue
- 2
- Pages
- 316-321
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3554314
- OpenAlex
- W2148678870
- Cited by
- 82
- References
- 34
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 5 · 2023: 10 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 8 · 2018: 7 · 2017: 6 · 2016: 4 · 2015: 13 · 2014: 5 · 2013: 6
- FWCI
- 7.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- diabetic retinopathy, type 1 diabetes, celiac disease, villous atrophy, disease duration, retinopathy risk factors, small bowel biopsy
- MeSH terms
- Adolescent, Adult, Celiac Disease, Child, Child, Preschool, Diabetes Mellitus, Type 1, Diabetic Retinopathy, Female, Humans, Infant, Infant, Newborn, Male, Risk Factors, Young Adult
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