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Published on: July 5, 2022
Celiac Disease Alone and Associated With Type 1 Diabetes Mellitus
Alexandra Tsouka1, Farid H Mahmud, Margaret A Marcon
1*Division of Endocrinology and Gastroenterology †Division of Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Children with type 1 diabetes and celiac disease (T1D/CD) showed a distinct, milder phenotype compared to those with celiac disease alone. Complication screening was inconsistent, suggesting a need for tailored follow-up guidelines.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Autoimmune Diseases
Background:
- Type 1 diabetes mellitus (T1D) and celiac disease (CD) often co-occur.
- Understanding the distinct clinical presentation and management of co-occurring T1D/CD is crucial.
Purpose of the Study:
- To evaluate complication screening and follow-up patterns in children with T1D/CD.
- To compare these patterns with a matched cohort of children with CD alone.
Main Methods:
- Retrospective review of health charts for 41 children with T1D and biopsy-proven CD.
- Comparison of anthropometrics and complication screening within 2 years of CD diagnosis.
- Analysis of follow-up patterns 3 years postdiagnosis, compared to a matched CD-only cohort.
Main Results:
- Patients with CD alone had significantly lower height, weight, and BMI z-scores compared to T1D/CD.
- CD-only patients had higher screening rates for anemia and bone health.
- Repeat serology was more frequent in the T1D/CD group; follow-up was variable in both groups.
Conclusions:
- T1D/CD patients may represent a distinct, potentially milder phenotype of CD.
- Complication screening was variable and largely negative.
- Tailored follow-up guidelines are needed to standardize evaluation and screening, particularly for bone health.
Objectives:
The aim of the study was to evaluate complication screening and follow-up patterns in a population with type 1 diabetes mellitus and celiac disease (T1D/CD) in relation to a matched cohort with celiac disease (CD) alone at our center.
Methods:
We retrospectively reviewed the health charts of 41 children with T1D and biopsy-proven CD and compared anthropometrics and complication of screening within 2 years from CD diagnosis. Follow-up patterns were determined 3 years postdiagnosis. This population was then compared with a population with both symptomatic and asymptomatic CD matched for age and sex.
Results:
In comparison with T1D/CD, patients with CD alone had a significantly lower height, weight and body mass index (BMI z score 0.01 vs 0.81, P = 0.001) and higher rates of screening for anemia (95% vs 71%, P = 0.003) and bone health (49% vs 29%, P = 0.05). Minimal rates of laboratory abnormalities were observed in either group, irrespective of symptoms at presentation, but CD alone more often presented with anemia than T1D/CD. Repeat serology testing was significantly more frequently performed in the T1D/CD group. Follow-up was equally variable with a median of 3 (range 0-4) visits with a gastroenterologist during the first 3 years postdiagnosis.
Conclusions:
These results suggest that patients with T1D/CD represent a distinct and possibly milder phenotype from CD alone. Complication screening was variable and negative for the majority of the patients. Guidelines for follow-up may need to be tailored to specific groups to standardize evaluation and complication screening, especially with regard to bone health.
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