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case management, celiac disease, celiac sprue, diabetes co-morbidities, special diet



  1. Greenberg, Liza RN, MPH


Purpose of study: The purpose of this article is to educate case managers on an autoimmune disorder, celiac disease, that is seen with increased frequency due to recent improvements in diagnostic testing. After reading this article, case managers will


* recognize common symptoms of and diagnostic approaches to celiac disease;


* be cognizant of clinical implications of untreated celiac disease, and the link between celiac disease and diabetes;


* understand the basic requirements of a gluten-free diet, including foods allowed, and the need to avoid cross-contamination of foods;


* identify common psychosocial implications of celiac disease and the treatment regimen, a lifelong gluten-free diet;


* identify other professionals such as gastroenterologists and nutritionists who may be involved in care of a patient with celiac disease;


* identify stressful situations and coping mechanisms for patients on a gluten-free diet; and


* demonstrate ability to find Web-based resources and other sources of support for patients.



Primary practice setting(s): Outpatient case management, although patients with celiac disease may be encountered in any setting.


Findings/conclusions: Celiac disease is a genetic autoimmune disease affecting up to 1% of the population. The majority of people with celiac disease do not know they have it. With new diagnostic tests available on the marketplace, increasing numbers of people are being diagnosed with celiac disease. Case managers are likely to encounter patients with celiac disease as either a primary or secondary diagnosis. Celiac disease may cause gastrointestinal symptoms such as gas, diarrhea, or bloating, and is also associated with osteoporosis, other autoimmune disorders, and certain types of cancer. For children, it is a common disorder underlying growth delays. Celiac disease is present in 3%-8% of persons with diabetes and may affect glycemic control in these patients. The only known treatment of celiac disease is a lifelong gluten-free diet. The increased number of individuals diagnosed with celiac disease has led to an increase in products available, as well as in research on treatment alternatives.


Implications for case management practice: People with celiac disease report challenges in adhering to the gluten-free diet. Case managers can assist patients in accessing appropriate therapy, including nutrition counseling and monitoring services. They may also advocate for testing of patients in high-risk groups such as persons with diabetes, and those with unexplained gastrointestinal symptoms. In working with celiac patients, case managers should address psychosocial issues as well as knowledge deficits. Patients may need particular support integrating the gluten-free diet with other requirements, including heart healthy or diabetic diets. Case managers can help patients identify reliable sources of information and products. Case managers still have a role to play in educating patients and supporting adherence with this lifelong dietary regimen.