ComplicationsLiving with Type 1 Diabetes

Celiac Disease and Type 1 Diabetes: A Connection?

Did you know that people with Type 1 diabetes also are at greater risk of having celiac disease? The odds of having celiac disease are 5 times to 7 times times greater for people with Type 1 diabetes than for the general population.

Celiac disease is an autoimmune condition that causes an inflammatory state of the small intestine in genetically predisposed individuals. Inflammation ceases when gluten is removed from the diet. Gluten is a protein that is found in wheat, rye, and barleys; some individuals also experience inflammation from oats, even with oats that haven’t been contaminated by gluten-carrying grains. When people with celiac disease eat foods containing gluten, their immune system responds by damaging the lining of the small intestine, which can then affect how nutrients are absorbed by the body.

SickKids_FullThe Hospital for Sick Children (SickKids) in Toronto is leading a study that looks into whether people with Type 1 diabetes who don’t have symptoms of celiac but test positive for it may benefit from a gluten-free diet. Called the Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET), this study is open to children and adults with Type 1 diabetes. It is being led by Dr. Farid Mahmud. Typically, celiac disease can cause symptoms such as diarrhea, weight loss, vomiting, constipation, malnutrition, abdominal pain and bloating, but more than half of people with Type 1 diabetes have no symptoms of celiac disease when they are diagnosed. Because of this, it is recommended that children and adults with diabetes undergo celiac screening.

As a part of the research study, SickKids is offering a blood test to determine whether you or your child has celiac disease. The research study is recruiting people (ages 8-45) who’ve had Type 1 diabetes for more than one year, who have not been previously diagnosed with celiac disease and exhibit no symptoms of the disease. Screening for celiac disease is ongoing across the Greater Toronto Area and the province of Ontario.

Presently, the only treatment available for celiac disease is a gluten-free diet. The diet is very strict and even very small amounts of gluten may damage the intestine. In other words, people with celiac disease must avoid most grain products including pastas, cereals, breads, and many processed foods. The goal of the CD-DIET study is to improve our understanding of the treatment options available to people living with both Type 1 diabetes and celiac disease.

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A dietitian can help you to plan a healthy gluten-free way of eating that will also allow you to manage your diabetes. It is important to learn how to properly read ingredient lists on food labels to identify foods that contain gluten and to make gluten-free choices in the grocery store and when eating out. It is also important to be aware of the carbohydrate content of the gluten-free foods and your portion sizes so you are able to properly match your insulin to your intake.

There is still a lot that we don’t know about celiac disease and Type 1 diabetes. Participating in the CD-DIET study allows you or your child the opportunity to help others living with Type 1 diabetes and celiac disease by improving our understanding of treatment options. You also could benefit from an accurate and definite diagnosis; celiac disease is often misdiagnosed and sometimes remains undiagnosed if patients don’t have the typical symptoms.

If you or someone you know is interested in learning more about the CD-DIET Study and would like to know which screening location is closest to you, please contact the CD-DIET Study Staff at (416) 813-7654 ext. 201713 or To learn more, go to


Many thanks to Lorraine Anderson from Animas Canada for her contribution to this article.

Photo Credit: ChameleonsEye /

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Farid Mahmud is Staff Physician in the Division of Endocrinology, Department of Paediatrics and Assistant Professor at the University of Toronto and Project Investigator at The Hospital for Sick Children Research Institute. He received his medical degree at The University of Alberta, Edmonton and trained in Paediatric Endocrinology and Metabolism at The Mayo Clinic, Rochester.

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