J Pediatr Endocrinol Metab. 2025 Jan 16. doi: 10.1515/jpem-2024-0070. Online ahead of print.

Lydia Ramharack ¹, Colin P Hawkes ^2 3 4, Paige Coughlin ¹, Lionola Juste ¹, Sando Ojukwu ^2 5 6, Steven M Willi ^2 6, Arunjot Singh ^1 6

Author information

¹Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

²Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

³Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.

⁴INFANT Research Centre, University College Cork, Cork, Ireland.

⁵Joslin Diabetes Center, Section on Clinical, Behavioral and Outcomes Research, Boston, Massachusetts, USA.

⁶Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

Objectives: The association of celiac disease (CD) in type 1 diabetes mellitus (T1DM) is well-established, yet variation exists in screening practices. This study measures the accuracy of early screening with tissue transglutaminase Immunoglobulin A (TTG-IgA) and endomysial antibody (EMA) in newly diagnosed T1DM.

Methods: This is a retrospective study of children with T1DM between 2013 and 2019 with early CD screening and follow-up. Data elements included anthropometrics, serologies, blood pH, bicarbonate, and Hemoglobin A1c. Celiac serologies were analyzed using chi-square and receiver operating characteristic curves to calculate optimal levels for predicting CD.

Results: A total of 1,292 children met inclusion criteria with 142 having positive celiac serologies; 47 (33.1 %) of whom were subsequently diagnosed with CD - an incidence of 3.6 %. All subjects with positive EMA and TTG-IgA ≥8 times upper limit of normal were diagnosed with CD. Gastrointestinal symptoms, BMI, and thyroid disease were not statistically significant variables in this cohort, although there was a trend toward CD in lower BMI patients and higher TTG IgA in those with markedly elevated HgbA1c.

Conclusions: Early celiac screening in T1DM is reliable and promotes timely CD diagnosis and treatment. Although transient positive celiac serologies were noted, the degree of TTG-IgA elevation and EMA positivity are strong predictors of coexisting CD. Larger prospective studies using these assays will further define the risk stratification algorithm that is needed for our T1DM community.