Based on findings of an international registry study, researchers recommend screening children and adolescents with type 1 diabetes for coexisting celiac disease and monitoring the height of those with coexisting diseases.
Maria E. Craig, PhD, FRACP, professor of pediatrics at the University of Sydney and The Children’s Hospital at Westmead, and colleagues evaluated data from the Prospective Diabetes Follow-up Registry (Germany/Austria), the T1D Exchange Clinic Network (United States), the National Paediatric Diabetes Audit (United Kingdom) and the Australasian Diabetes Data Network (Australia) on 52,721 children and adolescents with type 1 diabetes to determine international differences in prevalence and management of celiac disease and coexisting type 1 diabetes or type 1 diabetes only.
Overall, biopsy-proven celiac disease was present in 3.5% of participants. Prevalence of celiac disease was higher in girls (4.3%) compared with boys (2.7%; P < .001) and in participants younger than 5 years at diabetes diagnosis (4.8%) compared with participants aged at least 5 years at diabetes diagnosis (2.8%; P < .001). Prevalence of celiac disease was highest in the Australian registry (7.7%), followed by the U.K. (3.8%), German/Austrian (3.2%) and U.S. registries (1.9%). Participants with coexisting celiac disease and type 1 diabetes were younger at diabetes diagnosis (median age, 5.4 years) compared with participants with type 1 diabetes alone (median age, 7 years; P < .001). Height standard deviation score (SDS) was slightly lower in participants with celiac disease and type 1 diabetes compared with those with type 1 diabetes alone after adjustment for age, sex and diabetes duration (P < .001).
Most participants with celiac disease were diagnosed less than 1 year after diabetes diagnosis (37%), followed by years 3 to 5 of diabetes (23%), year 2 of diabetes (18%), after more than 5 years of diabetes (17%) and before the diagnosis of diabetes (5.4%).
“The findings support universal screening for [celiac disease] in patients with type 1 diabetes, particularly within the first 2 years after the diagnosis of diabetes, irrespective of ethnicity,” the researchers wrote. “Although the lower height SDS in those with [celiac disease] warrants further investigation using longitudinal data and documentation of adherence to the gluten-free diet, the observation emphasizes the importance of monitoring growth and nutrition in this population.” – by Amber Cox
Disclosures: Craig reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.