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A Population-Based Study of the Risk of Diabetic Retinopathy in Patients With Type 1 Diabetes and Celiac Disease
Karolinska Institutet, Stockholm, Sweden .
St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden .
Karolinska Institutet, Stockholm, Sweden and Örebro University Hospital, Örebro, Sweden .
Royal Hallamshire Hospital and University of Sheffield, Sheffield, U.K. .
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2013 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 36, no 2, 316-321 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
American Diabetes Association , 2013. Vol. 36, no 2, 316-321 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-90149DOI: 10.2337/dc12-0766ISI: 000314467100032OAI: diva2:612158

Funding Agencies|Stockholm County Council||Karolinska Institutet, Stockholm, Sweden||Sven Jerring Foundation||Ogonfonden||Swedish Society of Medicine||Swedish Research Council-Medicine|522-2A09-195|Orebro Society of Medicine||Karolinska Institutet||Orebro University Hospital||Clas Groschinsky Foundation||Juhlin Foundation||Majblomman Foundation||Uppsala-Orebro Regional Research Council||Swedish Celiac Society||

Available from: 2013-03-20 Created: 2013-03-20 Last updated: 2013-03-26

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Ludvigsson, Johnny
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PediatricsFaculty of Health SciencesDepartment of Paediatrics in Linköping
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