|
|||||
|
|
Annual screening detects celiac disease in children with type 1 diabetes |
|
| Authors: | Karin Larsson Annelie Carlsson Elisabeth Cederwall Björn Jönsson Jan Neiderud Björn Jonsson Åke Lernmark Sten A Ivarsson ; on behalf of the Skåne Study Group |
| Institution: | Department of Paediatrics, Kristianstad Hospital, Kristianstad, Sweden;;Department of Paediatrics, Lund University Hospital, Lund, Sweden;;Department of Paediatrics, Ängelholm Hospital, Ängelholm, Sweden;;Department of Paediatrics, Ystad Hospital, Ystad, Sweden;;Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden;;Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden;;Department of Clinical Sciences, University Hospital MAS, Malmö, Sweden;;Department of Medicine, University of Washington, Seattle, WA, USA;;and Department of Paediatrics, University Hospital MAS, Malmö, Sweden |
| Abstract: | Objective: To investigate the prevalence of celiac disease (CD) in a cohort of type 1 diabetes mellitus (T1DM) children and adolescents at the time of clinical diagnosis and to evaluate the screening procedure and possible role of human leukocyte antigen (HLA)-DQ during a 5-yr follow-up. Research design and methods: The study group was a cohort of 300 newly diagnosed T1DM children and youths younger than 20 yr followed for 5 yr at six clinical centers for pediatric diabetes in the region Skåne in Sweden. Immunoglobulin A endomysium antibodies were used to screen the patients annually to be considered for an intestinal biopsy. All patients were analyzed for HLA-DQA1-B1 genotypes. Results: While 0.7% (2/300) already had a diagnosed symptomatic CD, an additional 3% (10/300) had silent CD at the diagnosis of T1DM. During follow-up, another 6% (17/300) developed CD as follows: 10 after 1 yr, 5 after 2 yr, 1 after 3 yr, and 1 after 5 yr. Therefore, the cumulative frequency of CD confirmed by intestinal biopsies was 10% (29/300). HLA genotypes among T1DM patients developing CD were not different from those among patients with T1DM alone. Conclusions: Our study confirmed the low prevalence (0.7%) of diagnosed symptomatic CD at the time of clinical diagnosis but document by screening an increasing prevalence of silent CD during a 5-yr follow-up to reach an overall prevalence of 10%. We suggest that children with T1DM should be screened for CD at the onset of T1DM and annually for a minimum of at least 2 yr. HLA genotypes among T1DM patients developing CD were not different from those among patients with T1DM alone. |
| Keywords: | annual screening CD children HLA-DQ T1DM |