Association of coexisting celiac disease with macrovascular and microvascular complications in adults with type 2 diabetes mellitus: a retrospective propensity score–matched cohort study

Abstract Background Celiac disease (CD) and type 2 diabetes mellitus (T2DM) are increasingly recognized as overlapping metabolic conditions. However, the impact of concomitant CD on diabetes-related complications and metabolic outcomes in patients with T2DM remains poorly characterized. We aimed to compare clinical outcomes between patients with T2DM and CD versus patients without CD. Methods We performed a retrospective multicenter electronic health record (EHR)-based cohort study using the TriNetX research network. Adults with T2DM and concomitant CD were identified using ICD-10-CM codes for T2DM and CD, along with either markedly elevated tissue transglutaminase IgA levels or upper endoscopy procedures. Propensity score matching (1:1) was performed for demographics, cardiovascular risk factors, lipid disorders, medications, and laboratory markers, yielding 8,760 patients per cohort. Outcomes included albuminuria, depression, anxiety, severe hyperglycemia, ophthalmic complications, hospitalization, neuropathy, nephropathy, and a composite cardiovascular outcome. Results After matching, patients with T2DM and CD had significantly higher hazards of albuminuria (HR 1.30, 95% CI 1.15–1.46), depression (HR 1.14, 95% CI 1.07–1.21), anxiety (HR 1.12, 95% CI 1.06–1.18), severe hyperglycemia (HR 1.39, 95% CI 1.27–1.53), ophthalmic complications (HR 1.77, 95% CI 1.55–2.02), neuropathy (HR 1.73, 95% CI 1.59–1.88), nephropathy (HR 1.13, 95% CI 1.04–1.22), and a composite cardiovascular outcome (HR 1.09, 95% CI 1.01–1.17) compared with matched controls. Hospitalization risk did not differ between cohorts (HR 0.97, 95% CI 0.92–1.01). Mean follow-up after matching were 1,574 days and 1,438 days. Conclusions Among patients with T2DM, concomitant CD was associated with significantly higher risks of macro and microvascular diabetic complications, and psychiatric comorbidities.