ESPE Abstracts (2019) 92 P1-28

Elevated Anti-tissue Transglutaminase Antibodies in Children Newly Diagnosed with type 1 Diabetes do not Always Indicate Celiac Disease

Ahu Paketçi1, Coşkun Armağan2, İbrahim Mert Erbaş1, Korcan Demir1, Ayhan Abaci1, Ece Böber1

1Dokuz Eylul University, Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey. 2Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, İzmir, Turkey

Introduction: The prevalence of celiac disease is 5–10 times higher in patients with type 1 diabetes mellitus (DM) than in the general population. Therefore, celiac serology should be screened intermittently in type 1 DM patients. However, anti-tissue transglutaminase (anti-TTG) antibody elevation may be detected incidentally at the time of type 1 DM diagnosis and regress spontaneously during follow-up, without medical or dietary interventions.

Objective: The aim of this study was to determine the prevalence of spontaneous normalization of anti-TTG in type 1 DM patients with positive anti-TTG titers at time of DM diagnosis, and the factors associated with this phenomenon.

Methods: Patients who were diagnosed with type 1 DM between July 1999 and May 2018 and whose anti-TTG levels were tested at time of diagnosis were included in the study. Clinical, laboratory, and treatment data of the patients were recorded. Patients with high anti-TTG titer were divided into two groups for statistical analysis: those whose celiac serology was positive at diagnosis and spontaneously normalized during follow-up, and those who were diagnosed with celiac disease.

Results: A total of 294 patients (142 male[48.3%], 152 female [51.7%]) with a mean age of 9,08 years (1,08–17,75 years) were included in the study. Elevated anti-TTG titer was detected in 9.5% (n=28) of the patients at the time of diagnosis. Of these, 60.7% (n=17) were diagnosed with celiac disease with consistent biopsy findings, while 39.3% (n=11) exhibited spontaneous normalization of celiac serology. Patients who were later diagnosed with celiac disease had higher mean HbA1c level at time of DM diagnosis compared to the patients who showed spontaneous normalization of anti-TTG serology (11.2% vs. 8.9%; P<0.05). Anti-TTG titers greater than 10 times the upper limit at time of DM diagnosis were observed in 52.9% of the celiac patients, compared to 9.1% of the patients that showed spontaneous normalization (P<0.05) (Table 1). Anthropometric measurements and gastrointestinal symptoms did not differ significantly between the two groups (Table 1).

Conclusion: Type 1 DM patients may have high anti-TTG titers at the time of diagnosis. However, this is not always an indicator of celiac disease, and antibody titers may normalize during follow-up. In the literature, spontaneous normalization of anti-TTG antibody titers is reported in 35.4–59% of type 1 DM patients. Consistent with the literature, this rate was 39.3% in our study. For this reason, monitoring antibody titers should be considered for asymptomatic patients with mild anti-TTG antibody elevation at time of DM diagnosis before recommending gluten-free diet and referring for biopsy. Screening for celiac disease at least 6 months after type 1 DM diagnosis is a more rational approach.

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