Celiac disease and celiac serology in children with Type 1 Diabetes: diagnostic timing, serologic patterns, and implications for long-term management.

Abstract

The prevalence of celiac disease (CeD) in children with type 1 diabetes mellitus (T1DM) is significant, and celiac serology screening is routinely done in T1DM patients. The sequence of CeD and T1DM diagnosis and the natural history of transient celiac serology in T1DM is poorly defined. We aimed to investigate the temporal relationship between T1DM and CeD diagnoses, and the long-term natural history of celiac serology and CeD diagnosis in children with T1DM. A retrospective cohort study of 1,799 children with T1DM, treated at a single tertiary center (2009-2024), was evaluated for clinical, laboratory, and histologic data. Patients with positive anti-tissue-transglutaminase IgA antibodies (anti-TTG) were stratified based on CeD diagnosis or long-term serological behavior on a gluten-containing diet. Among 136 patients with T1DM and positive anti-TTG, 113 were diagnosed with CeD, 15 had persistent seropositivity (without confirmed CeD), and eight had a single borderline result (< ×3 upper limit of normal). CeD was diagnosed after T1DM in 81.4% of cases, and prior to TIDM in 18.6%. Patients diagnosed with CeD prior to T1DM exhibited more gastrointestinal symptoms, higher EMA positivity, and poorer glycemic control (p < 0.05). HbA1c values at follow-up were significantly higher in patients with CeD, compared to those with a single borderline anti-TTG, p < 0.01. In conclusion, most, but not all, patients with T1DM and elevated celiac serology, eventually develop biopsy-confirmed CeD. CeD can precede T1DM in a significant number of cases, emphasizing the need for continued monitoring for celiac serology in children diagnosed with T1DM and monitoring for developing T1DM in patients with CeD.