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

## TL;DR

This study shows that screening for celiac disease in children with type 1 diabetes is most useful when they show symptoms, as antibody levels can disappear over time without symptoms.

## Contribution

The study provides long-term clinical insights into celiac screening in children with type 1 diabetes, suggesting symptom-based screening is more effective.

## Key findings

- Highly elevated celiac antibodies can disappear in children with type 1 diabetes over time.
- Only 12 out of 304 children with T1D were confirmed to have celiac disease.
- Symptomatic children are more likely to have persistent celiac disease.

## Abstract

Objective: Children with type 1 diabetes (T1D) have an increased risk of developing additional autoimmune diseases. The risk of developing celiac disease (CD) is 3–4 times higher in children with T1D. Guidelines recommend regular screening for transglutaminase antibodies (TgAbs) in T1D children. CD could be an additional burden for T1D children as both diseases affect food intake. We describe the screening practice for CD during the last 25 years in our outpatient clinic in children with T1D.

Methods: We retrospectively analyzed the development of CD-specific antibodies in our children with T1D (diabetes onset since 1998). We did not routinely recommend endoscopy when CD-specific antibodies (TgAb, endomysium [EAb], and gliadin) were positive and patients had no CD-specific symptoms.

Results: We analyzed 304 patients. In total 122 had CD-specific antibodies. In 98 of them, they disappeared after a short time or had been only slightly elevated. The diagnosis of CD was confirmed in 12. All 12 showed CD-specific symptoms, such as failure to thrive, anemia, hypoglycemia, or gastrointestinal problems. In six patients, even severely elevated EAb and/or TgAb disappeared on average after 7.1 years (range 4.9–13.5 years) on gluten-containing diet. The remaining six had antibodies without CD-specific symptoms by the end of the observation period. In this group the duration of antibody-positivity was 4 years (range 1.8–11.6 years).

Conclusion: We conclude that even highly elevated CD-specific antibodies can disappear in children with T1D and that screening for CD-specific antibodies is therefore only useful in symptomatic children with T1D.