December 16, 2020

Celiac and Diabetes: Myriad challenges in the frontier

From ancient Greeks the known occurrence of Celiac Disease has been reported. The word Celiac refers to “Abdomen” and hence Celiac Disease as we know it today is the autoimmune disorder of the intestines caused by the consumption of Gluten.This is the same protein that is mostly found in grains like wheat, barley, rye and is responsible for making the dough elastic and providing a chewy texture to the bread.

Patients suffering from Celiac Disease experience issues in their digestion and bowels as Gluten reacts hyperactively with their body and in turn damages the villi of the small intestine. Diarrhea, bloating, excess gas, fatigue,weight loss, Iron-Deficiency Anemia, Constipation, Itchy Rash and Depression are common symptoms of Celiac Disease. The long term effects of Celiac Disease include loss of bone density, miscarriage, infertility or even neurological diseases or certain cancers.

In recent times, numerous studies have shown that India shares 1% of the total reported global Celiac occurrence cases. The challenges are compounded due to lack of awareness, late diagnosis, manifestations by other ailments and lifestyle habits. It must be noted that the comorbidity in the patients is high with celiac Disease and Diabetes. India, as of today, ranks second globally in Diabetic incidence and, the malabsorption of nutrients poses a huge risk to patients suffering from symptomatic hypoglycemia. Intake of food to absorption of the same and the change in the villi anatomy with and without patients with Celiac Disease in Diabetic cohort across various age groups have suggested that the existence of both the ailments has long lasting damage to the overall metabolism of the body and also to the intestines with the emergence of deficiency of vitamins, minerals and other important constituents in the body. Jejunal Biopsy of the patients suggested the impact of gluten absorption compounded with hypoglycemic incidence. The only solution to the recovery of these patients has been the introduction of a Gluten Free Diet (GFD), and this ensures that the intestinal mucosa returns to normalcy and accordingly decreases the incidence of Hypoglycemia.

Screening patients for Celiac Disease routinely and the introduction of Point of Care Testing (POCT) Diagnostic kits are the first step to address the solutions. All the labs and the healthcare establishments have introduced routine panels for testing Diabetes with various markers, and it is imperative to include Celiac testing with the same. J Mitra & Co has been striving hard in this domain for couple of years and has provided solutions both in POCT, ELISA and FIA domains for Hb1Ac and Celiac respectively.

Biopsy of the intestine stands out to be the gold standard for testing Celiac Disease, but it is only limited to late diagnosis, and hence for early detection, the serological kits take predominance. The Celiac ELISA kit made by J Mitra & Co. is simple to use and economical and helps in rapid screening of the general population for the detection of latent or subclinical Celiac disease. Moreover, the RDT or ELISA advantage over the Anti-endomysial test (EMA) is that it is not labor intensive and doesn’t require any waiting period for the patients. To add to the Lab and the patient’s benefit, the ELISA test provided by J Mitra & Co. also has the option of reporting in both Semi Quantitative and Quantitative modes. Furthermore, the FIA kit for Hb1Ac can correlate the levels for Diabetic patients quantitatively.

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