Screening for celiac disease in children and adolescents with type 1 diabetes, what to do?

Achón Buil Ana Pilar; Marina García-Boente; Matus Sáez Tania Constanza; Cuartero Beatriz García; Fernández Khusama Alkadi; Frías María Martín; Andrés Beatriz Corredor; Ariño Garbiñe Roy; Valverde Rosa Yelmo; Roldán Martín María Belén

P2-320

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ESPE Abstracts (2024) 98 P2-320

ESPE2024 Poster Category 2 Late Breaking (107 abstracts)

Screening for celiac disease in children and adolescents with type 1 diabetes, what to do?

Ana Pilar Achón Buil ¹ , Marina García-Boente ¹ , Tania Constanza Matus Sáez ¹ , Beatriz García Cuartero ¹ , Khusama Alkadi Fernández ¹ , María Martín Frías ¹ , Beatriz Corredor Andrés ² , Garbiñe Roy Ariño ¹ , Rosa Yelmo Valverde ¹ & María Belén Roldán Martín ¹

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¹Hospital Universitario Ramón y Cajal, Madrid, Spain. ²Hospital Universitario de Toledo, Toledo, Spain

Introduction: The reported prevalence of celiac disease (CD) in paediatric patients with type 1 diabetes mellitus (T1D) ranges from 1.6 to 16.4%, with a tendency to increase in recent years. Most clinical guidelines recommend screening for CD at the diagnosis of T1D but conclude different recommendations regarding subsequent screening, hence the importance of providing new data in this population group.

Methods: We present a descriptive and retrospective study of a cohort of paediatric patients diagnosed with T1D in a tertiary hospital, and followed up between October 1998 and May 2023.

Results: 467 patients aged up to 18 years were included, 49.9% were girls. The mean age at diagnosis of T1D was 6.67 years (IQR: 3.21-10.35), with no differences in age at diagnosis by sex. The prevalence of CD was 7.7% (95%CI 5.30-10.15), mean age at diagnosis was 5.47 years (IQR: 2.74-9.89).13.8% of children had been diagnosed with CD before the onset of T1D. 55.6% of patients were diagnosed with CD during the first year after T1D diagnosis and 30.6% after the first year (81.8% within the first 5 years after diagnosis T1D and the remaining 18.2% 5 to 8 years after). IgA anti-transglutaminase antibody (tTG-A) levels were 10 times higher than the upper limit of normal (ULN) in 38.9% patients, and in all of these cases the diagnosis of CD was confirmed by duodenal biopsy. HLA was performed in 26/36 CD patients, all of whom had high-risk HLA haplotypes (DQ2+/-DQ8). 38 out of 467 patients (8.1%) had positive CD serology at diagnosis of T1D. CD antibodies were transient in 28.9% of the cases and became negative during the first year of follow-up, while 71.1% of the patients were diagnosed with CD. In the whole series of patients, three were diagnosed with potential CD (0.6%). They had elevated tTG-A levels (less than 10 times the ULN) 3, 4 and 10 years after diagnosis of T1D, high- risk HLA haplotypes and type 0/1 Marsh lesions in biopsies. Gamma-delta lymphocytes were elevated in all of them.

Conclusion: Autoimmunity to CD may be transient at diagnosis of T1D in children and adolescents. The finding of tTG-A levels above 10 times the ULN may be sufficient for the diagnosis of CD in patients with T1D. Screening for CD is essential during the first 5 years after T1D diagnosis but it is necessary to continue screening beyond this interval during childhood.