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Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac-specific antibody-negativity-A
Katrin Nagl1, Esther Bollow2,3, Susanne Liptay4
1Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
Insights
Only one-third of pediatric patients with type 1 diabetes and celiac disease achieved antibody negativity within three years. Achieving antibody negativity correlated with better metabolic control and growth, suggesting improved therapy adherence.
Area of Science:
- Endocrinology
- Gastroenterology
- Immunology
Background:
- Type 1 diabetes (T1D) and celiac disease (CD) often co-occur in pediatric patients.
- Monitoring celiac-specific antibody status is crucial for managing T1D+CD patients.
- Longitudinal studies are needed to understand antibody dynamics and clinical outcomes.
Purpose of the Study:
- To investigate celiac-specific antibody status over three years in pediatric patients with T1D+CD.
- To identify clinical differences between antibody-negative (Ab-neg) and antibody-positive (Ab-pos) patients post-diagnosis.
- To compare outcomes in T1D+CD patients with T1D-only patients.
Main Methods:
- Longitudinal analysis of 608 pediatric T1D+CD patients from the DPV registry.
- Assessment of CD-specific antibody status over three years post-biopsy.
- Comparison of clinical parameters (HbA1c, lipids, growth) between Ab-neg, Ab-pos, and T1D-only groups using regression analyses.
Main Results:
- 36% of T1D+CD patients achieved sustained antibody negativity within three years; median time to negativity was 0.86 years.
- Ab-neg patients exhibited lower HbA1c, total cholesterol, LDL-cholesterol, and dyslipidemia frequency compared to T1D-only patients.
- Ab-pos patients showed persistently higher HbA1c and lower height-SDS over six years compared to Ab-neg patients.
Conclusions:
- Sustained antibody negativity is achieved by only one-third of pediatric T1D+CD patients.
- Achieving antibody negativity is associated with improved metabolic control and growth.
- Adherence to therapy may play a significant role in achieving antibody negativity and better clinical outcomes.
Objectives:
To study celiac-specific antibody status over 3 years in patients with type 1 diabetes and biopsy-proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody-negativity (Ab-neg) and staying antibody-positive (Ab-pos).
Methods:
A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody-status. Differences between Ab-neg (n = 218) and Ab-pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background.
Results:
Thirty-six percent of T1D + CD patients reached and sustained antibody-negativity 3 years after CD diagnosis. The median time until patients returned to Ab-neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab-neg and highest in Ab-pos patients compared to T1D-only patients (adjusted mean (95%CI): 7.72 (7.51-7.92) % vs 8.44 (8.20-8.68) % vs 8.19 (8.17-8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL-cholesterol and frequency of dyslipidemia were significantly lower in Ab-neg compared to T1D-only patients (167 (161-173) mg/dl vs 179 (178-179) mg/dl, P < .001; 90 (84-96) mg/dl vs 99 (98-99) mg/dl, P = .005; 15.7 (10.5-22.9) % vs 25.9 (25.2-26.6) %, P = .017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c (P < .001) and a lower height-SDS (P = .044) was observed in Ab-pos compared to Ab-neg patients.
Conclusion:
Only one third of T1D + CD patients reached constant Ab-negativity after CD diagnosis. Achieving Ab-negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.
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