Thong EP, et al. - The clinicians conducted this study to assess fracture prevalence and to investigate associations with glycaemic control, hypoglycaemia and microvascular disease in Type 1 diabetes mellitus (T1DM) + coeliac disease (CD) compared with T1DM alone. They found an independent association between CD status with increased fracture prevalence in young adults with T1DM. Moreover, in T1DM+CD, recurrent hypoglycaemia was increased, although hypoglycaemia was not independently associated with fractures. They recommended prospective studies to determine the long-term impacts of the CD on bone health and on glycemic control in T1DM.

Methods

• Between August 2016 and February 2017, the clinicians performed a retrospective cross-sectional study of young adults with T1DM, who attended diabetes clinics at a large tertiary referral centre.
• They extracted clinical information, radiological and biochemistry results from medical records.
• They excluded patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism.

Results

• The clinicians included 346 patients with T1DM alone (median age 23 years) and 49 patients with T1DM+CD (median age 24 years).
• Between groups, median age, gender distribution, BMI, haemoglobin A1c, daily insulin dose and serum 25-hydroxyvitamin D levels were similar.
• They observed higher adjusted fracture riskin T1DM+CD compared with T1DM (12.2% vs. 3.5%; OR 3.50, 95% CI 1.01–12.12, p=0.01), yet bone mineral density was only measured in 6% of patients.
• For T1DM+CD, the adjusted risk of hypoglycaemia ≥2/week was greater (55% vs. 38%, OR 3.28, 95% CI 1.61–6.69, p=0.001), however, this was not independently associated with fractures.
• Replete vitamin D (≥ 50 nmol/L) was correlated with less hypoglycaemia (OR 0.48, 95% CI 0.29-0.80; p=0.005), but not with fractures.