title: Spontaneous normalization of anti-tissue transglutaminase antibody levels is common in children with type 1 diabetes mellitus.
abstract: BACKGROUND
  The prevalence of celiac disease among type 1 diabetes mellitus (T1DM) patients is 5-10 times higher than in the general population. Thus, evaluation of celiac serology is indicated at diagnosis of T1DM and on follow up.
  
  
  OBJECTIVE
  This study was prompted by the observation that elevated anti-TTG antibody levels in diabetic children may spontaneously normalize despite continued consumption of gluten. The objective of the study was to investigate the prevalence of this phenomenon and associated factors.
  
  
  METHODS
  The files of all children diagnosed with type 1 diabetes mellitus from 2003-2009 at a tertiary pediatric medical center were reviewed for those with elevated serum levels of anti-TTG antibody. Clinical, medical, laboratory, and treatment data were collected. Findings were compared between patients diagnosed with celiac disease and patients with initially elevated anti-TTG antibody levels that spontaneously normalized.
  
  
  RESULTS
  Forty-eight of the 738 patients with type 1 diabetes attending our center (6.5%) had elevated anti-TTG antibody blood levels. Celiac disease was diagnosed in 23, and anti-TTG antibody levels normalized in 17 (35.4%), all of whom consumed gluten. At one-year follow-up, there was no significant difference between the groups in HbA1c level or change in anthropometric measurements.
  
  
  CONCLUSIONS
  Physicians treating children with type 1 diabetes and mildly elevated anti-TTG antibody levels might consider 12-month serologic follow-up on a gluten-containing diet rather than immediate duodenal biopsy.
authors.affiliation: Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202 Petach Tikva, Israel. oritwz@netvision.net.il
authors.forename: Orith
authors.initials: O
authors.lastname: Waisbourd-Zinman
authors.forename: Iva
authors.initials: I
authors.lastname: Hojsak
authors.forename: Yoram
authors.initials: Y
authors.lastname: Rosenbach
authors.forename: Yael
authors.initials: Y
authors.lastname: Mozer-Glassberg
authors.forename: Shlomit
authors.initials: S
authors.lastname: Shalitin
authors.forename: Moshe
authors.initials: M
authors.lastname: Phillip
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D000906:Antibodies / Q000097:blood*; D058070:Asymptomatic Diseases; D002446:Celiac Disease / Q000209:etiology / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002662:Child Health Services; D015362:Child Nutrition Disorders / Q000175:diagnosis* / Q000209:etiology; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D055050:Diet, Gluten-Free; D005260:Female; D005983:Glutens / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D012075:Remission, Spontaneous; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000906:Antibodies; D005983:Glutens; D006442:Glycated Hemoglobin; D011503:Transglutaminases