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Published on: July 5, 2022
Managing Children and Adolescents with Type 1 Diabetes and Coexisting Celiac Disease: Real-World Data from a Global
Maja Raicevic, Francesco Maria Rosanio1, Tiago Jeronimo Dos Santos2
1Institute for Children's Diseases, Clinical Centre of Montenegro, Podgorica, Montenegro.
Insights
Physicians show varied practices in managing celiac disease (CD) in children with type 1 diabetes (T1D). More specific guidelines and education are needed, particularly in lower-income nations, to improve care for these patients.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Diabetes Management
Background:
- Type 1 diabetes (T1D) and celiac disease (CD) frequently co-occur in children.
- Current diagnostic and management practices for CD in pediatric T1D patients vary globally.
Purpose of the Study:
- To assess international physician attitudes and practices regarding CD diagnosis and management in children with T1D.
- To identify needs for improved guidelines and physician education.
Main Methods:
- A 30-item survey was distributed to pediatricians interested in T1D and CD.
- Responses were collected from 180 physicians across 25 countries between July and December 2023.
- Data analyzed to identify trends in practice and influencing factors.
Main Results:
- Most physicians (62.2%) found managing T1D + CD more challenging than T1D alone.
- A significant majority (81.1%) called for more specific clinical guidelines.
- Physician practices and follow-up routines for T1D + CD patients differed, with higher income countries showing better adherence to guidelines.
Conclusions:
- Significant variations exist in managing CD in pediatric T1D patients.
- There is a clear need for enhanced physician education and specialized guidelines, especially for lower-income countries.
- Multidisciplinary clinics are recommended for optimal follow-up care of these children.
Introduction:
Celiac disease (CD) is among the diseases most commonly associated with type 1 diabetes (T1D). This study aimed to evaluate the worldwide practices and attitudes of physicians involved in pediatric diabetes care regarding diagnosing and managing CD in children with T1D.
Methods:
The 30-item survey was conducted between July and December 2023 aimed at targeting pediatricians with special interest in T1D and CD. It was shared by the JENIOUS - young investigators group of the International Society of Pediatric and Adolescent Diabetes (ISPAD) - and the YES - early career group of the European Society for Pediatric Endocrinology (ESPE).
Results:
Overall, 180 physicians (67.8% female) from 25 countries responded. Among respondents, 62.2% expected sustaining optimal glycemic control in children with T1D and CD (T1D + CD) to be more difficult than in children with T1D alone. Majority (81.1%) agreed that more specific guidelines are needed. The follow-up routine for patients with T1D + CD differed, and one-quarter of physicians scheduled more frequent follow-up checkups for these patients. Seventy percent agreed multidisciplinary outpatient clinics for their follow-up is needed. In the multivariate ordinal logistic regression model, a statistically significant predictor of a higher degree of practice according to ISPAD 2022 guidelines was a higher level of country income (OR = 3.34; p < 0.001).
Conclusions:
These results showed variations in physicians' practices regarding managing CD in children with T1D, emphasizing the need for more specific guidelines and intensive education of physicians in managing this population, especially in lower-income countries. Our data also suggest the implementation of multidisciplinary outpatient clinics for their follow-up.
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