Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a clinic based population

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Abstract
Background: Although the association between type 1 diabetes mellitus (T1DM) and coeliac disease is well known, the presenting features and clinical characteristics of the two diseases when they coexist are less well documented. Methods: All patients with T1DM attending a paediatric diabetes clinic in London, UK, were screened for coeliac disease by serological testing for coeliac antibodies (antiendomysial and either/both tissue transglutaminase and antigliadin). Antibody positive patients were reviewed and their presenting symptoms, tissue biopsy result and coexisting morbidities investigated. Glycaemic control, growth and the effect of a gluten-free diet on these variables were also evaluated. Results: Of the 113 patients with T1DM, 7 (6.2%) tested antibody positive. Jejunal biopsy confirmed coeliac disease in 5 of the 7 (4.4%) patients. Coeliac disease presented atypically or silently in the majority of cases with an unpredictable interval between diagnosis of diabetes and coeliac disease presentation. Coeliac disease did not appear to affect growth. Mean glycated haemoglobin (HbA1c) levels were not significantly raised in subjects (9.87%) compared with matched controls without coeliac disease (9.08%) (p = 0.249). Analyses of the effect of a gluten-free diet on growth and HbA1c were limited. Of the seven subjects, two suffered other autoimmune diseases. Conclusion: Coeliac disease presents atypically and unexpectedly in children and adolescents with T1DM. This, along with the strong association between the two diseases, supports the regular screening of coeliac disease among these patients. The value of a gluten-free diet cannot be commented on from this study alone although other studies show it reduces the risk of complications.