Background: Celiac disease is an important association of type 1 diabetes with significant impact on growth and glycemic control. Identification of the disease in asymptomatic subjects highlights the need for celiac screening in type 1 diabetes. Disparity in screening guidelines suggests the need for exploration of time trend and predictors of the association.
Objective: To estimate the time trend, prevalence and predictors of celiac disease in children and adolescents with type 1 diabetes.
Methods: Time trend and predictors of celiac disease were studied in 203 children and adolescents with type 1 diabetes (105 boys) followed up for 4.8 (3.6) years with baseline and annual tissue transglutaminase (TTG) antibody levels in our Pediatric Endocrinology Clinic.
Results: Celiac disease was identified in 36 subjects (17.7%) during the course of study (3 before diagnosis, 19 at initial screening and 14 on follow-up). Twenty two subjects had elevated TTG at diagnosis of diabetes with biopsy proven disease in 19. Subjects with celiac disease at diagnosis had compromised growth reflected by lower weight standard deviation score [SDS -1.5 (1.4) as against -0.3 (1.1), P < 0.001] and BMI SDS [-0.9 (0.8) as against -0.1 (1.2), P = 0.009] than those without the disease. Celiac disease was identified in 14 subjects with normal initial TTG level after a mean follow up of 3.9 (2.9) years (range 1.5 to 12.6 years). Incident celiac disease was identified in 12 (85.7%) within five years of diabetes diagnosis and after 7 and 12 years in the remaining two. Subjects with incident celiac disease had compromised growth [weight SDS of - 1.1 (- 0.3) as against -0.3 (1.2), P = 0.03] and glycemic control [HBA1C of 11.8 (3.7) as against 9.5 (2), P = 0.003] than those without the disease. Importantly none of the subjects with incident celiac disease had gastrointestinal symptoms.
Conclusion: Celiac disease is common in type 1 diabetes with development of the disease usually within five years of diagnosis. Lack of gastrointestinal symptoms highlights the need for annual monitoring for the condition till at least five year of diagnosis.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology