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Performance of Celiac Serologic Markers and Follow-Up Adherence in Children with Type 1 Diabetes and Comorbid Celiac

Leslie Saba1, Marie Chen2, Roland Hentz3

  • 1Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA, saba.leslie@mayo.edu.

Hormone Research in Paediatrics
|January 7, 2026
PubMed

Insights

Children with type 1 diabetes mellitus (T1D) have a higher risk of celiac disease (CeD). This study found that a tissue transglutaminase IgA level 3.62 times the upper limit of normal can help diagnose CeD in these children.

Area of Science:

  • Pediatric Endocrinology
  • Gastroenterology
  • Immunology

Background:

  • Children with type 1 diabetes mellitus (T1D) have an increased risk of developing celiac disease (CeD).
  • Co-occurrence of T1D and CeD presents unique diagnostic and management challenges.
  • Understanding diagnostic performance and follow-up is crucial for optimizing care.

Purpose of the Study:

  • To evaluate the diagnostic performance of celiac serology in children with T1D.
  • To assess CeD follow-up rates in children with co-morbid T1D and CeD.
  • To determine optimal cut-offs for celiac disease confirmation in this population.

Main Methods:

  • Retrospective review of children diagnosed with T1D between 2000-2021.
  • Analysis of tissue transglutaminase (TTG) IgA and endomysial antibody (EMA) results.
  • Comparison of CeD diagnosis and follow-up between children with T1D+CeD and CeD-only groups.

Main Results:

  • A TTG IgA level ≥ 3.62 times the upper limit of normal (ULN) effectively discriminated between biopsy-confirmed CeD and non-CeD (90% sensitivity, 92% specificity).
  • Positive EMA results had 100% sensitivity and 100% negative predictive value for confirming CeD in children with T1D and positive TTG IgA.
  • TTG IgA normalization took significantly longer in children with T1D+CeD (median 6.5 years) compared to CeD-only (median 1.2 years).
  • Pediatric gastroenterology follow-up rates were lower in the T1D+CeD group.

Conclusions:

  • A TTG IgA level ≥ 3.6 times ULN or positive EMA are recommended for proceeding with CeD confirmation in children with T1D.
  • In cases of mild TTG IgA elevation, EMA can aid CeD confirmation due to its high negative predictive value.
  • Children with T1D and CeD require longer periods for serological normalization and may have reduced follow-up rates, highlighting the need for tailored management strategies.
Abstract

Keywords:
Celiac diseaseFollow-up visitsMultidisciplinary careType 1 diabetes

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