Introduction: The association between type 1 diabetes (T1D) and celiac disease (CD) has been described by many authors in both children and adults. The link between these two pathologies was identified more than 30 years ago, especially by pediatricians. The aim of this work was to study the clinical, biological, and evolutionary features of CD in diabetic children compared to a control group of non-celiac diabetic children.
Patients and Methods: Retrospective study of a cohort of 20 T1D children with CD compared to a control group of 20 non-celiac diabetic children collected in the Pediatric Department of Tahar Sfar University Hospital of Mahdia over 30 years.
Results: The prevalence of CD in children with diabetes was 2.7%. Diabetes was revealed in celiac children by ketoacidosis in 70% of cases versus 40% in controls. The mean duration of diabetes progression was 8.8 ± 1.8 years in celiac patients versus 10.2 ± 2.1 years in controls. The mean age of discovery of CD was 7.2 ± 3.1 years, 3.4 years in mean after the discovery of diabetes with a sex ratio of 1.5. At the time of diagnosis of CD, 50% of children were asymptomotic, 40% had growth delay, 14% had abdominal pain, 16% recurrent hypoglycaemia, 7% chronic diarrhea, 62% anemia, and 75% CD positive antibodies. Jejunal biopsies showed total villous atrophy in 40% of cases, subtotal villous atrophy in 30% of cases and partial villous atrophy in 30% of cases. Gastric biopsy revealed associated Helicobacter pylori gastritis in 50% of cases.
After initiating a gluten-free diet, 64% of celiac children had poor diet adherence because of their low socioeconomic status. Short stature was observed in 52% of celiac patients versus 15% of controls. Hypoglycemia was a cause of re-hospitalization twice as common in celiac children than in the control group. Mean HbA1C in celiac patients was 10.6% versus 9.1% in controls.
Conclusion: Our study echoes those in the literature by emphasizing the high prevalence of CD among children with diabetes that is higher than that seen in the general population. The high prevalence of DT1-CD in our series justifies routine screening for CD in diabetic children. This may improve the balance of diabetes in children with CD, especially those with digestive symptoms or stunting, and avoid the complications of CD.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology