title: Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up.
abstract: OBJECTIVE
  To determine the benefits of screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibodies (TG) in children with type 1 diabetes (T1D).
  
  
  METHODS
  We followed up 79 screening-identified TG+ and 56 matched TG- children with T1D for 2 years to evaluate growth, bone mineral density, nutritional status, and diabetes control. TG+ subjects self-selected to gluten-free or gluten-containing diet.
  
  
  RESULTS
  Of the initial cohort, 80% were available for reexamination after 2 years. TG+ subjects had consistently lower weight z-scores and higher urine N-telopeptides than TG- subjects, but similar measures of bone density and diabetes outcomes. TG+ children who remained on a gluten-containing diet had lower insulin-like growth factor binding protein 3 z-scores compared with TG+ subjects who reported following a gluten-free diet. Children who continued with high TG index throughout the study had lower bone mineral density z-scores, ferritin, and vitamin D 25OH levels, compared with the TG- group.
  
  
  CONCLUSIONS
  No significant adverse outcomes were identified in children with T1D with screening-identified TG+ who delay therapy with a gluten-free diet for 2 years. Children with persistently high levels of TG may be at greater risk. The optimal timing of screening and treatment for celiac disease in children with T1D requires further investigation.
authors.affiliation: Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt Children's Hospital, Nashville, TN, USA. jill.h.simmons@vanderbilt
authors.forename: Jill H
authors.initials: JH
authors.lastname: Simmons
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
authors.forename: Kim
authors.initials: K
authors.lastname: McFann
authors.forename: Marian
authors.initials: M
authors.lastname: Rewers
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Ide
authors.forename: Iman
authors.initials: I
authors.lastname: Taki
authors.forename: Edwin
authors.initials: E
authors.lastname: Liu
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hoffenberg
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D015551:Autoimmunity / Q000276:immunology*; D001707:Biopsy, Needle; D016022:Case-Control Studies; D002446:Celiac Disease / Q000178:diet therapy / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis / Q000276:immunology; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors; D011503:Transglutaminases / Q000032:analysis / Q000276:immunology
chemical_list: D007070:Immunoglobulin A; D011503:Transglutaminases
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