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Celiac Disease in Children With Type 1 Diabetes: The Usefulness of Screening- 25 years of Experience in a Single

Roland Schweizer1, Julia I Bung1, David Majer1

  • 1Pediatric Diabetology, University Children's Hospital, Tübingen, Germany.

Pediatric Diabetes
|August 11, 2025
PubMed

Insights

Screening for celiac disease (CD) antibodies in children with type 1 diabetes (T1D) may not be beneficial unless symptoms are present. Even high antibody levels can resolve in T1D patients without symptoms.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Autoimmune Diseases

Background:

  • Children with type 1 diabetes (T1D) face a higher risk of developing other autoimmune conditions, including celiac disease (CD).
  • Current guidelines suggest routine screening for transglutaminase antibodies (TgAbs) in T1D children to detect CD.
  • Both T1D and CD impact dietary intake, potentially complicating management for affected children.

Purpose of the Study:

  • To retrospectively analyze the screening practices and outcomes for celiac disease (CD) in children with type 1 diabetes (T1D) over a 25-year period.
  • To evaluate the significance and persistence of CD-specific antibodies in asymptomatic T1D children.

Main Methods:

  • Retrospective analysis of CD-specific antibody development (TgAb, endomysium [EAb], gliadin) in T1D children diagnosed since 1998.
  • Endoscopy was not routinely performed for positive antibody results in asymptomatic patients.
  • Patient data, including antibody levels, symptoms, and disease progression, were reviewed.

Main Results:

  • Out of 304 T1D patients analyzed, 122 showed CD-specific antibodies.
  • In 98 patients, antibodies were transient or mildly elevated; 12 were diagnosed with CD, all exhibiting symptoms.
  • Among patients with confirmed CD, severely elevated antibodies resolved in some over time, even on a gluten-containing diet. Other patients had persistent antibodies without symptoms.

Conclusions:

  • Highly elevated CD-specific antibodies can spontaneously disappear in children with T1D.
  • Routine screening for CD-specific antibodies in T1D children may only be valuable when clinical symptoms are present.
  • The findings suggest a need to reconsider universal screening protocols for CD in asymptomatic T1D pediatric populations.

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