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Interpreting positive celiac serology in children with new-onset type 1 diabetes

Lydia Ramharack1, Colin P Hawkes2,3,4, Paige Coughlin1

  • 1Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Journal of Pediatric Endocrinology & Metabolism : JPEM
|January 15, 2025
PubMed

Insights

Early screening for celiac disease (CD) in children with type 1 diabetes mellitus (T1DM) using tissue transglutaminase immunoglobulin A (TTG-IgA) and endomysial antibody (EMA) is accurate. High levels of TTG-IgA and positive EMA strongly predict CD in this population.

Area of Science:

  • Endocrinology
  • Gastroenterology
  • Immunology

Background:

  • Type 1 diabetes mellitus (T1DM) is frequently associated with celiac disease (CD).
  • Screening practices for CD in T1DM patients vary.
  • Accurate early screening is crucial for timely diagnosis and management.

Purpose of the Study:

  • To evaluate the accuracy of early celiac disease screening in newly diagnosed children with T1DM.
  • To determine the predictive value of tissue transglutaminase immunoglobulin A (TTG-IgA) and endomysial antibody (EMA) for CD in T1DM.
  • To assess the incidence of CD in a pediatric T1DM cohort.

Main Methods:

  • Retrospective analysis of 1,292 children with T1DM diagnosed between 2013 and 2019.
  • Inclusion of anthropometric data, serologies (TTG-IgA, EMA), blood pH, bicarbonate, and Hemoglobin A1c.
  • Statistical analysis using chi-square and ROC curves to identify optimal cutoff levels for CD prediction.

Main Results:

  • An overall incidence of 3.6% for CD was observed (47 out of 1,292 children).
  • Positive EMA and TTG-IgA levels ≥8 times the upper limit of normal were 100% predictive of CD.
  • Gastrointestinal symptoms, BMI, and thyroid disease were not significant predictors, though a trend towards lower BMI and higher TTG-IgA with elevated HgbA1c was noted.

Conclusions:

  • Early screening for celiac disease in T1DM patients is reliable and facilitates prompt diagnosis and treatment.
  • Elevated TTG-IgA and EMA positivity are strong indicators of coexisting CD in T1DM.
  • Further prospective studies are needed to refine risk stratification algorithms for CD screening in T1DM.
Abstract

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