Celiac autoantibody positivity in relation to clinical characteristics in children with type 1 diabetes
Background: Type 1 diabetes is an autoimmune disorder with a high risk of celiac disease (CD).
Aim: This study aimed to determine the celiac autoantibody status and the clinical characteristics among children with type 1 diabetes and autoantibody positivity for celiac disease compared to those without serological evidence of celiac disease.
Materials and methods: In this cross-sectional study, 240 children with type 1 diabetes underwent serological screening CD. Blood glucose, glycated hemoglobin (HbA1c), hemoglobin, calcium, phosphorous, vitamin D, alanine aminotransferase (ALT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and gamma glutamyl transferase (GGT) were evaluated. The participants were screened for human anti-endomysial antibody and human anti-tissue transglutaminase antibody.
Results: Of the 240 children with type 1 diabetes, 66 children were antibody positive for either anti-endomysial or anti-tissue transglutaminase or both autoantibodies for CD. There were 36 (54.5%) female and 30 (45.5%) male children with mean age 15.5±2.1 years. The mean duration of diabetes was 6.8±3.8 years. Only 35 (14.6%) children were found to have serological evidence of CD.
Conclusion: CD is associated with type 1 diabetes. Serological screening for CD autoantibody should be performed routinely in children with type 1 diabetes. There is discrepancy in screening CD with antibodies, so a prospective follow up of this cohort is needed for endoscopic evaluation and histopathological examination of intestinal biopsy to confirm CD in this population. Relevance for patients: Anti-endomysial and anti-tissue transglutaminase autoantibodies should be included for screening CD among children with type 1 diabetes. Patients should undergo an endoscopy to confirm a diagnosis of CD.

[1] Leonard MM, Sapone A, Catassi C, Fasano A. Celiac Disease and Nonceliac Gluten Sensitivity: A Review. JAMA 2017;318:647-56.
[2] Kurppa K, Laitinen A, Agardh D. Coeliac Disease in Children with Type 1 Diabetes. Lancet Child Adolesc Health 2018;2:133-43.
[3] Aljebreen AM, Almadi MA, Alhammad A, Al Faleh FZ. Seroprevalence of Celiac Disease among Healthy Adolescents in Saudi Arabia. World J Gastroenterol 2013;19:2374-8.
[4] Al-Hussaini A, Troncone R, Khormi M, AlTuraiki M, Alkhamis W, Alrajhi M, et al. Mass Screening for Celiac Disease among School-aged Children: Toward Exploring Celiac Iceberg in Saudi Arabia. J Pediatr Gastroenterol Nutr 2017;65:646-51.
[5] Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. J Pediatr Gastroenterol Nutr 2012;54:136-60.
[6] American Diabetes Association. Standards of Medical Care Indiabetes: 2014. Diabetes care 2014;37:S14-80.
[7] Rubio-TapiaA, Hill ID, Kelly CP, CalderwoodAH, Murray JA. ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. Am J Gastroenterol 2013;108:656-76.
[8] Al-Hussaini A, Sulaiman N, Al-Zahrani M, Alenizi A, El Haj I. High Prevalence of Celiac Disease among Saudi Children with Type 1 Diabetes: A Prospective Cross- sectional Study. BMC Gastroenterol 2012;12:180.
[9] Agrawal RP, Rathore A, Joshi A, Changal H, Kochar DK. Prevalence of Celiac Disease in Type 1 Diabetes Mellitus in North West Rajasthan, India. Diabetes Res Clin Pract 2008;79:e15-6.
[10] Farrell RJ, Kelly CP. Celiac Sprue. N Engl J Med 2002;346:180-8.
[11] Al-HussainiA, Alharthi H, Osman A, Eltayeb-Elsheikh N, Chentoufi A. Genetic Susceptibility for Celiac Disease is Highly Prevalent in the Saudi Population. Saudi J Gastroenterol 2018;24:268-73.