Diabetologia. 2022 Jul;65(7):1108-1118. doi: 10.1007/s00125-022-05701-w. Epub 2022 Apr 30.

Clemens Kamrath ¹, Sascha R Tittel ^2 3, Desiree Dunstheimer ⁴, Elke Fröhlich-Reiterer ⁵, Markus Freff ⁶, Claudia Böttcher ⁷, Nadine Scheffler ⁸, Stefanie Lenze ⁹, Elke Gericke ¹⁰, Susanne Thiele ¹¹, Reinhard W Holl ^2 3

Author information

¹Division of Paediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany. clemens.kamrath@paediat.med.uni-giessen.de.

²Institute of Epidemiology and Medical Biometry (ZIBMT), Ulm University, Ulm, Germany.

³German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.

⁴Division of Paediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, University Children's Hospital Augsburg, Augsburg, Germany.

⁵Department of Paediatrics and Adolescent Medicine, Division of General Paediatrics, Medical University of Graz, Graz, Austria.

⁶Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany.

⁷Paediatric Endocrinology and Diabetology, University Children's Hospital, University of Bern, Bern, Switzerland.

⁸Centre for Paediatrics and Adolescent Medicine, Neonatology and Paediatric Intensive Care, Clinic Itzehoe, Itzehoe, Germany.

⁹Centre of Diabetes, Department of Paediatrics, Sana Klinikum Berlin Lichtenberg, Berlin, Germany.

¹⁰Centre of Child and Adolescent Medicine, Mathias-Spital Rheine, Rheine, Germany.

¹¹Centre of Diabetes, Hospital of Child and Adolescent Medicine, St Vincenz Hospital, Paderborn, Germany.

Abstract

Aim: Screening for coeliac disease in asymptomatic children with new-onset type 1 diabetes is controversial. The aim of this study was to analyse whether the confirmation of coeliac disease in children with new-onset type 1 diabetes and positive screening results can be postponed.

Methods: This was a multicentre population-based cohort study based on the German/Austrian/Swiss/Luxembourgian Prospective Diabetes Follow-up Registry (Diabetes Patienten Verlaufsdokumentation [DPV]). Participants aged ≤18 years diagnosed with type 1 diabetes between 1995 and June 2021 and with elevated IgA tissue transglutaminase antibodies (anti-tTGA) at diabetes onset on screening for coeliac disease were included. We compared outcomes of participants with a diabetes duration of more than 1 year between those in whom coeliac disease was confirmed histologically within the first 6 months and those in whom coeliac disease was confirmed between 6 and 36 months after diabetes diagnosis.

Results: Of 92,278 children and adolescents with a diagnosis of type 1 diabetes, 26,952 (29.2%) had documented anti-tTGA data at diabetes onset. Of these, 2340 (8.7%) had an elevated anti-tTGA level. Individuals who screened positive were younger (median age 9.0 vs 9.8 years, p<0.001) and more often female (53.1% vs 44.4%, p<0.001). A total of 533 participants (22.8% of those who screened positive) had a documented biopsy, of whom 444 had documented histological confirmation of coeliac disease. Of 411 participants with biopsy-proven coeliac disease within the first 36 months of diabetes and follow-up data, histological confirmation was performed in 264 (64.2%) within the first 6 months and in 147 (35.8%) between 6 and 36 months after diabetes onset. At follow-up (median diabetes duration 5.3 years and 5.1 years, respectively), estimated median HbA_1c levels (62.8 mmol/mol vs 62.2 mmol/mol [7.9% vs 7.8%]), cardiovascular risk markers (lipids, rate of microalbuminuria, blood pressure), rates of acute diabetes complications (diabetic ketoacidosis, severe hypoglycaemia) and the proportions of participants reaching anti-tTGA levels within the normal range did not differ between groups. Participants with delayed histological confirmation of coeliac disease showed no negative effects on growth or weight gain during the observation period.

Conclusions: Our study suggests that the histological confirmation of coeliac disease in asymptomatic individuals with new-onset type 1 diabetes could be postponed.