Type 2 Diabetes with Celiac Disease Shows Higher Complication Risk

PATIENTS with Type 2 diabetes mellitus (T2DM) and coexisting celiac disease (CD) had higher risks of several macrovascular and microvascular complications than matched patients with T2DM without CD, according to a retrospective cohort study. 

Study Design and Population 

Researchers conducted a retrospective, multicentre electronic health record-based cohort study using the TriNetX research network. Adults with T2DM and concomitant CD were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes for both conditions, alongside either markedly elevated tissue transglutaminase immunoglobulin A levels or upper endoscopy procedures. 

Propensity score matching was used to balance demographic characteristics, cardiovascular risk factors, lipid disorders, medications, and laboratory markers between the groups. Following one to one matching, each cohort included 8,760 patients. Mean follow-up was 1,574 days for patients with T2DM and CD and 1,438 days for matched controls. 

Celiac Disease and Complication Risk 

The data showed that patients with T2DM and CD had significantly higher risks across several outcomes. Albuminuria was more common in this group (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.15–1.46), while severe hyperglycaemia was also more likely (HR: 1.39; 95% CI: 1.27–1.53). 

Ophthalmic complications and neuropathy showed particularly pronounced associations. Patients with T2DM and CD had a higher risk of ophthalmic complications (HR: 1.77; 95% CI: 1.55–2.02) and neuropathy (HR: 1.73; 95% CI: 1.59–1.88). Nephropathy was also associated with CD (HR: 1.13; 95% CI: 1.04–1.22). 

The analysis also identified higher risks of depression (HR: 1.14; 95% CI: 1.07–1.21), anxiety (HR: 1.12; 95% CI: 1.06–1.18), and the composite cardiovascular outcome (HR: 1.09; 95% CI: 1.01–1.17). Hospitalisation risk did not differ significantly between the groups (HR: 0.97; 95% CI: 0.92–1.01). 

Clinical Implications of Celiac Disease 

The findings suggest that coexisting CD may be associated with a broader burden of complications among patients with T2DM, spanning microvascular, macrovascular, metabolic, and psychiatric outcomes. 

The researchers concluded that concomitant CD was associated with significantly higher risks of macrovascular and microvascular diabetic complications and psychiatric comorbidities. These findings highlight the potential additional clinical burden associated with CD among adults with T2DM. 

Reference 

Prado R, Silva ML. Association of coexisting celiac disease with macrovascular and microvascular complications in adults with type 2 diabetes mellitus: a retrospective propensity score-matched cohort study. Endocrine. 2026;91(1):314.