Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up.
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.
Simmons
Jill H
JH
Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt Children's Hospital, Nashville, TN, USA. jill.h.simmons@vanderbilt
Klingensmith
Georgeanna J
GJ
McFann
Kim
K
Rewers
Marian
M
Ide
Lisa M
LM
Taki
Iman
I
Liu
Edwin
E
Hoffenberg
Edward J
EJ
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
D007070:Immunoglobulin A; D011503:Transglutaminases
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