Endocrine Abstracts

Introduction: Type 1 diabetes and celiac disease are two autoimmune pathologies that frequently coexist. This association implies specific nutritional management whose application by the patient is not always simple. We report An extream case of malabsorption in a patient with type 1 diabetes and celiac disease.

Case presentation: This was the case of a 34-year-old with type 1 diabetes (T1D), celiac disease and vitiligo evolving since 13, 7 and 2 years respectively. She reported poor socio-economic conditions and no compliance with insulin therapy and gluten-free diet. Her weight and height were of 52.4 kg and 154 cm respectively, i.e. a BMI of 22.1 kg/m². On impedancemetry, her body composition was characterized by a fat mass of 29.2%. Her total energy intake was hypocaloric (TEI) (1931.6 cal/d), hypoglucidic (2.8 g/kg/d), hypolipidic (0.73 g/kg/d) and hypoprotidic (0.85 g/kg/d), according to WHO recommendation. Likewise, her diet was rich in high glycemic index carbohydrates (15.5% of TEI) and sodium (2195 mg/d), and poor in fiber (21.5 g/d), B12 vitamin (1.78 µg/d), calcium (617 mg/d), iron (7.6 mg/d) and potassium (2020 mg/d). Her diabetes was uncontrolled (HbA1C=9.1%) and complicated by pathologic microalbuminuria (36.4 mg/24H) put on ACE inhibitors. She had no hypoglycemia. Her celiac disease was complicated by a malabsorption syndrom: She had chronic hypocalcemia (2.24 mmol/l) and chronic hypovitaminosis D, complicated with secondary hyperparathyroidism with Looser Milkman streaks on her pelvis x-ray, well tolerated microcytic hypochromic anemia (9.8 g/dl) due to iron deficiency (Ferritinemia=6.65 ng/ml) and chronic hypolkaliemia (3.6 mmol/l). Liver test and TSH were normal. She was put on gluten-free diet and supplementation (calcium carbonate 500 mg 2 times a day, Ergocalciférol 2000UI/d, ferrous sulfate 80 mg 2 times a day, potassium chloride 600 mg/d and B 12 vitamin an injection of 1000 µg each month).

Conclusion: Managing the case of our patient was challenging. Multiple supplementation effectiveness is discussed given the risk of interaction between micronutrients. Likewise, their bioavailability is not guaranteed given the intestinal lesions of celiac disease. Total adherence to free-gluten diet remains the cornerstone of the treatment.