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Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up

Jill H Simmons1, Georgeanna J Klingensmith, Kim McFann

  • 1Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt Children's Hospital, Nashville, TN, USA. jill.h.simmons@vanderbilt

The Journal of Pediatrics
|September 7, 2010
PubMed

Insights

Screening for celiac autoimmunity in children with type 1 diabetes (T1D) showed no immediate adverse effects from delaying a gluten-free diet. Persistently high TG antibody levels may indicate increased risk.

Area of Science:

  • Pediatric Endocrinology
  • Autoimmune Diseases
  • Gastroenterology

Background:

  • Type 1 diabetes (T1D) is an autoimmune condition often co-occurring with other autoimmune disorders.
  • Celiac autoimmunity, screened via immunoglobulin A transglutaminase autoantibodies (TG), is more prevalent in individuals with T1D.
  • The benefits and risks of early screening and intervention for celiac autoimmunity in T1D pediatric populations are not fully understood.

Purpose of the Study:

  • To evaluate the benefits of screening for celiac autoimmunity using TG autoantibodies in children diagnosed with T1D.
  • To assess the impact of delayed gluten-free diet therapy on growth, bone health, nutritional status, and diabetes control in TG+ children with T1D.

Main Methods:

  • A 2-year follow-up study involving 79 children with T1D identified as TG+ (positive for TG autoantibodies) and 56 matched TG- controls.
  • Assessment of growth parameters (weight z-scores), bone mineral density, nutritional status (ferritin, vitamin D), and diabetes control.
  • TG+ subjects were allowed to self-select between a gluten-free or gluten-containing diet.

Main Results:

  • TG+ subjects exhibited lower weight z-scores and higher urine N-telopeptides compared to TG- subjects, with no significant differences in bone density or diabetes outcomes.
  • Children with T1D who continued a gluten-containing diet showed lower insulin-like growth factor binding protein 3 z-scores than those on a gluten-free diet.
  • Persistently high TG index levels correlated with reduced bone mineral density z-scores, lower ferritin, and vitamin D 25OH levels.

Conclusions:

  • Delaying gluten-free diet therapy for up to 2 years in TG+ children with T1D did not result in significant adverse outcomes.
  • Children with persistently elevated TG levels may face increased health risks.
  • Further research is needed to determine the optimal timing for screening and initiating treatment for celiac disease in children with T1D.
Abstract

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