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Gastrointestinal symptoms in children with type 1 diabetes screened for celiac disease

Priya Narula1, Lesley Porter, Josephine Langton

  • 1Department of Gastroenterology, Birmingham Children's Hospital, Birmingham, UK. priyanarula28@hotmail.com

Pediatrics
|August 27, 2009
PubMed

Insights

Children with type 1 diabetes mellitus (DM) and celiac disease (CD) often experience gastrointestinal symptoms, contrary to previous beliefs. A gluten-free diet (GFD) significantly improves symptoms and nutritional status in these children.

Area of Science:

  • Pediatric Endocrinology
  • Gastroenterology
  • Autoimmune Diseases

Background:

  • Type 1 diabetes mellitus (DM) is associated with celiac disease (CD).
  • CD in DM patients is often considered asymptomatic.
  • Screening standards for CD in children with DM require audit.

Purpose of the Study:

  • Audit current CD screening practices in children with DM against published standards.
  • Characterize growth and GI symptoms in children with DM and biopsy-confirmed CD compared to those with negative celiac serology.
  • Evaluate the 1-year impact of a gluten-free diet (GFD) on GI symptoms, growth, and insulin requirements.

Main Methods:

  • Retrospective case-note review of 22 children with DM and positive celiac serology (with or without biopsy-confirmed CD).
  • Comparison group included 50 children with DM and negative celiac serology.
  • Standardized celiac serology testing was performed in 94% of cases.

Main Results:

  • 17 children (3% of the diabetic population) had biopsy-confirmed CD.
  • 76.4% of children with CD presented with at least one gastrointestinal symptom, significantly higher than the 6% in the control group (P < .0005).
  • A GFD led to symptom resolution and significant improvements in weight and BMI SD scores after 1 year.

Conclusions:

  • Children with DM and CD are not asymptomatic and exhibit a higher prevalence of GI symptoms.
  • Implementing a GFD positively impacts nutritional status and resolves symptoms in the short term.
  • Current screening practices should be aligned with established standards.
Abstract

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