Background: Routine screening for Coeliac disease (CD) beyond the first year of diagnosis with Type 1 Diabetes Mellitus (T1DM) is controversial due to a paucity of high-quality evidence. The UK guidelines (NICE) only recommend screening at diagnosis with T1DM or if subsequently symptomatic; whereas the International Society for Paediatric and Adolescent Diabetes (ISPAD) recommends routine screening every 1 to 2 years.
Objective and hypotheses: We hypothesised that annual screening for CD in asymptomatic children with T1DM is more sensitive than only screening when newly diagnosed with T1DM or symptomatic.
Method: A retrospective observational study was undertaken in a large general hospital that screens annually for CD. An open cohort was studied using electronic and paper records for all patients with T1DM, who had been under the care of Paediatrics at anytime from 2005 to 2014. Patients with Type 2 Diabetes Mellitus were excluded. Data were extracted in relation to demographics, screening for CD, TTG results, small bowel biopsy, and defined symptoms suspicious for CD.
Results: We identified 187 (90.78%) patients with T1DM who were tested for CD. The proportion of tested patients who were diagnosed with CD was 9.63% (95% CI=5.413.86%). Analysis of 16 patients with CD revealed that only five (31.25%) were diagnosed through screening at the point of presentation with T1DM, and two (12.5%) were diagnosed following testing prompted by clinical suspicion. The majority (56.25%) were diagnosed by routine screening whilst asymptomatic, ranging from 1 year and 9 months to 6 years and 9 months after their diagnosis with T1DM.
Conclusion: This study supports growing evidence that the UK guidelines should mirror the ISPAD recommendation to routinely screen for CD beyond the first year of presentation with T1DM. Targeted RCTs and studies of cost-effectiveness may provide evidence to recommend putative screening intervals.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology