Coexistence of celiac disease & type 1 diabetes mellitus in children

Abstract

Background & objectives:Type 1 diabetes mellitus (T1DM) and celiac disease (CD) tend to co-exist due to similar underlying genetic predisposition. Failure to recognize CD in patients with T1DM predisposes them to complications. The present study was aimed to assess children with T1DM for the presence of CD.Methods:This was a retrospective analysis of the records of children with T1DM attending paediatric endocrinology clinic at a tertiary care hospital in north India from January 2006 to May 2014. All children were screened for CD at the time of diagnosis of T1DM using IgA anti-tissue transglutaminase (anti-tTG) levels in serum. Seropositive children were subjected to upper gastrointestinal endoscopy and duodenal biopsy for histopathological confirmation. The children also underwent thyroid function testing (TFT); those with deranged TFT were evaluated for thyroid-specific antibodies.Results:Positive serology for CD was present in 43 of 126 children with T1DM whose records were reviewed [34.1%; 95% confidence interval (CI): 25.9-43.1]. Confirmed CD was diagnosed in 17 (13.5%; CI: 8.1-20.7) of the children screened and 17 of 40 (42.5%; CI: 27.1-59.1) seropositive participants. Four out of 17 children with coexisting CD and T1DM also had autoimmune thyroiditis with overt hypothyroidism. The children with confirmed CD were more likely to have short stature [odds ratios (OR)-3.16; 95% CI: 1.09-9.20, P<0.05] and hypothyroidism (OR-6.4; 95% CI: 1.52-26.90, P<0.05).Interpretation & conclusions:Our study showed a higher proportion of CD in children with T1DM as compared to that reported in general population. Regular screening of children with T1DM for CD is needed to improve metabolic control and prevent long-term complications.

Current Paediatric Coeliac Disease Screening Strategies and Relevance of Questionnaire Survey

“…Most screening studies on the prevalence of CD include diabetic children and adolescents, persons with thyroid disorders, persons with Down syndrome and those with close relations with CD (some of these are given by country in Table 3 [52-67]). The high prevalence of CD among patients with type 1 diabetes mellitus (up to 13.5%) is probably due to clinical and pathogenic overlap [68], and symptoms are often modest or absent.…”

Profile of auto-antibodies (Disease related and other) in children with type 1 diabetes

“…Studies done earlier from this country had shown a 34.1% prevalence of celiac disease associated anti-tissue transglutaminase IgA antibody in subjects with T1DM. [ 14 ] Another study from the country had shown a prevalence of 11.1% of celiac disease associated autoantibody in T1DM. [ 15 ] We appreciate that, before declaring a patient to be negative for celiac antibody by IgA, anti-tTG, total IgA deficiency must be excluded.…”

Celiac disease & type 1 diabetes: A double burden

“…In Indian patients with T1DM, a variable frequency of seropositivity of tTG antibody and CD has been reported. The frequency was reported to be higher in patients of north Indian origin (tTG antibody 11-34%; CD 3.8-13.5%) compared with a study from southern India (tTG antibody 5%)121314. The reason for this is not clear, but it may be due to the differences in frequency of genetic susceptibility loci or environmental factors such as the age of initiating gluten-containing foods in infancy.…”