Coeliac disease in children and adolescents with type 1 diabetes: a study of growth, glycaemic control, and experiences of families

Saukkonen, Tero; Väisänen, Sari; Åkerblom, H. K.; Savilahti, Erkki; Tuomilehto, J.; Lounamaa, R; Toivanen, Liisa; Kaprio, Eero A.; Virtala, Esa; Pitkäniemi, J.; Fagerlund, Åse; Flittner, M.; Gustafsson, Bengt; Häggqvist, C.; Hakulinen, A.; Herva, L.; Hiltunen, Pauliina; Huhtamäki, T.; Huttunen, N. P.; Huupponen, T; Hyttinen, Marko; Joki, T.; Jokisalo, R.; Käär, M.‐L.; Kaski, U.; Knip, Mikael; Laine, Loren; Lappalainen, Jani; Mäenpää, J; Mäkelä, Anna‐Liisa; Niemi, Katri; Niiranen, A.; Ojajärvi, P.; Otonkoski, Timo; Pihlajamäki, K.; Pöntynen, S.; Rajantie, Jukka; Sankala, J.; Schumacher, John; Sillanpää, Markus; Ståhlberg, Marja‐Riitta; Stråhlmann, C. H.; Uotila, T.; Väre, M.; Varimo, P.; A, Aro; Hiltunen, Merja; Hurme, H.; Hyöty, Heikki; Ilonen, Jorma; Karjalainen, J.; Leinikki, Pauli; Miettinen, Aaro; Petäys, Tuula; Reijonen, Helena; Räsänen, L; Reunanen, Antti; Tuomilehto‐Wolf, Eva; Vähäsalo, Paula; Virtanen, S. M.

doi:10.1080/08035250252833950

Cited by 26 publications

(22 citation statements)

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“…Many centers already advocate routine screening for CD in children with T1DM, but the appropriate interval between reexamination is unclear. Some have supported screening at diagnosis and then annually (6, 8, 16), others recommend screening at diagnosis of T1DM and then after 1, 3, and 5 yr (32). However, the conclusion based on our results is that children with T1DM should be screened for CD at the onset of T1DM and annually, at least for 2 yr.…”

Section: Discussionmentioning

confidence: 73%

Annual screening detects celiac disease in children with type 1 diabetes

Larsson

Carlsson²,

Cederwall³

et al. 2008

Pediatric Diabetes

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Our study confirmed the low prevalence (0.7%) of diagnosed symptomatic CD at the time of clinical diagnosis but document by screening an increasing prevalence of silent CD during a 5-yr follow-up to reach an overall prevalence of 10%. We suggest that children with T1DM should be screened for CD at the onset of T1DM and annually for a minimum of at least 2 yr. HLA genotypes among T1DM patients developing CD were not different from those among patients with T1DM alone.

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Section: Discussionmentioning

confidence: 73%

Annual screening detects celiac disease in children with type 1 diabetes

Larsson

Carlsson²,

Cederwall³

et al. 2008

Pediatric Diabetes

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“…In recent years various studies have been published on the effects of GFD on metabolic control and growth in children with CD and T1D. Westman et al showed no difference in growth parameters while others demonstrated a non‐significant increase in BMI standard deviation scores (SDS), reduction in glycosylated haemoglobin (HbA1c), and an increase in weight for height (5–7). The present study reviews the short‐term clinical and metabolic effects of a GFD in a group of children with T1D and confirmed CD.…”

mentioning

confidence: 78%

Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease

et al. 2011

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“…In contrast, the argument against early GFD includes difficulty in handling the dietary, lifestyle, and medication management changes inherent in the care of children with both T1D and CD and lack of clear benefit in asymptomatic children 23. In children with T1D, those with evidence of symptomatic CD benefit from GFD 4,24; in asymptomatic cases the demonstrated benefit is limited to weight gain and BMD changes 25,8,5,26. In any case, adherence to GFD by children with T1D is only about 50% 4,27,28,29,30.…”

Section: Discussionmentioning

confidence: 99%

Celiac Autoimmunity in Children with Type 1 Diabetes: A Two-Year Follow-Up

Simmons

Klingensmith

McFann

et al. 2011

The Journal of Pediatrics

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Objective-To determine the benefits of screening for celiac autoimmunity via IgA transglutaminase autoantibodies (TG) in children with type 1 diabetes (T1D).Study design-We followed 79 screening-identified TG+ and 56 matched TG− children with T1D for 2 years to evaluate growth, bone mineral density, nutritional status, and diabetes control. TG+ subjects self-selected to gluten-free or gluten-containing diet.Results-Of the initial cohort, 80% were available for re-examination after 2 years. TG+ subjects had consistently lower weight z-scores and higher urine N-telopeptides than TG− subjects, but similar measures of bone density and diabetes outcomes. TG+ children who remained on a gluten-containing diet had lower IGF-BP3 z-scores compared with TG+ subjects who reported following a gluten-free diet. Children who continued with high TG index throughout the study had lower bone mineral density z-scores, ferritin, and vitamin D 25OH levels, compared with the TG− group.Conclusions-No significant adverse outcomes were identified in children with T1D with screening-identified TG+ who delay GFD therapy for 2 years. Children with persistently high levels of TG may be at greater risk. The optimal timing of screening and treatment for CD in children with T1D requires further investigation.Keywords type 1 diabetes; pediatric; celiac disease; tissue transglutaminase autoantibodies; screening; gluten; diet Up to 16% of children with type 1 diabetes mellitus (T1D) have celiac disease (CD) 1,2,3,4,5 . Routine screening using IgA transglutaminase autoantibody (TG) has been recommended Corresponding author and reprint request author: Jill Simmons, MD, 11136 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9170, (615) 936-1874 (office) (615) 343-5845 (fax), jill.h.simmons@vanderbilt.edu. The authors declare no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript 6,7 . However, important unanswered questions remain regarding benefit of gluten-free diet (GFD) in screening-identified TG+ children with T1D. Even though high TG levels are specific for biopsy-confirmed CD, low-positive TG may be associated with negative biopsy but may be a risk factor for future CD. The optimal timing of GFD initiation in screeningidentified TG+ children, with or without T1D, remains unclear. The child with T1D and CD faces two life-long changes in diet, yet untreated CD has been associated with recurrent hypoglycemia and poor glycemic control.We previously reported baseline data reg...

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Coeliac disease in children and adolescents with type 1 diabetes: a study of growth, glycaemic control, and experiences of families

Abstract: Coeliac disease is rarely associated with signs of malabsorption in children and adolescents with type I diabetes. Introduction of a gluten-free diet may be associated with excess weight gain. We recommend intensified follow-up for these subjects.

Cited by 26 publications

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Annual screening detects celiac disease in children with type 1 diabetes

Annual screening detects celiac disease in children with type 1 diabetes

Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease

Celiac Autoimmunity in Children with Type 1 Diabetes: A Two-Year Follow-Up

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