Prevalence of celiac disease in Indian children with type 1 diabetes.
BACKGROUND
Type 1 diabetes (T1D) patients are at an increased risk of having celiac disease (CD). We evaluated the prevalence and clinical profile of CD in children and adolescents with T1D and reviewed the Indian literature to determine prevalence and reasons for variability.


METHODS
In this cross-sectional study, subjects with T1D were prospectively evaluated with a demographic and gastrointestinal (GI) questionnaire, human IgA-tissue transglutaminase (IgA-tTGA), and endoscopic duodenal biopsy in serology positive patients. Studies evaluating prevalence of CD in T1D from India were reviewed.


RESULTS
Fourteen (13.6 %) of the 103 (52 boys, 13 years [2-20]) T1D patients were IgA-tTGA (182 U [47-300]) positive and 3.8 % (4/103) had villous atrophy on histology. Subjects with T1D and CD (n = 4) were younger at onset of T1D (32.5 ± 12.6 vs. 110.5 ± 53.8 months; p < 0.005) and more often had GI symptoms (pain abdomen [2/4 vs. 6/89; p = 0.01], stool frequency of 2-3/day [3/4 vs. 38/89; p = 0.004]) than screen negative T1D (n = 89). Growth and glycemic control were not different between the groups. In the 7 Indian studies involving 915 children and adults, 13.8 % (8 % to 17.8 %) T1D were serology positive. Prevalence of CD was reported as 6.9 % (2.3 % to 11.1 %), but only 3.1 % (2.3 % to 4.2 %) had villous atrophy on histology.


CONCLUSIONS
Potential CD and CD were present in 13.6 % and 3.8 % children with T1D respectively. T1D with CD have onset of diabetes at younger age and were more often symptomatic than screen negative T1D.
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India. avanianshu@yahoo.com.
Anshu
http://orcid.org/0000-0003-0902-4140
A
Srivastava
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Saurabh
S
Chaturvedi
Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Preeti
P
Dabadghao
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Amrita
A
Mathias
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Umesh
U
Shukla
Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Uttam
U
Singh
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
Surender Kumar
SK
Yachha
D000293:Adolescent; D017668:Age of Onset; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies
Celiac disease; Children; Prevalence; Screening; Type 1 diabetes mellitus
Diabetes Care. 2015 May;38(5):760-6
25784659
Diabet Med. 1996 May;13(5):464-70
8737029
Arch Dis Child. 2004 Sep;89(9):871-6
15321869
Int J Pediatr Endocrinol. 2010;2010:161285
20652072
Eur J Intern Med. 2013 Jul;24(5):456-60
23414771
Aliment Pharmacol Ther. 2013 Aug;38(3):226-45
23782240
Diabetes Care. 2004 Jun;27(6):1294-8
15161778
Ann N Y Acad Sci. 2002 Apr;958:214-7
12021109
Aliment Pharmacol Ther. 2014 Nov;40(10):1123-32
25270960
Diabet Med. 2005 Aug;22(8):1079-82
16026376
World J Diabetes. 2013 Aug 15;4(4):130-4
23961323
Diabet Med. 2009 Dec;26(12):1250-4
20002477
Diabetes Res Clin Pract. 2008 Jan;79(1):e15-6
17720274
J Pediatr Gastroenterol Nutr. 2010 Jan;50(1):54-60
19644397
Dig Dis Sci. 2012 May;57(5):1314-20
22173747
Lancet. 2009 Jun 13;373(9680):1999-2000
19481250
Curr Diab Rep. 2014 Aug;14(8):517
24952108
Pediatrics. 2015 Jul;136(1):e170-6
26077482
Gastroenterology. 1992 Jan;102(1):330-54
1727768
Gut. 2013 Jan;62(1):43-52
22345659
Pediatr Diabetes. 2014 Sep;15 Suppl 20:270-8
25182319
J Gastroenterol Hepatol. 2011 Feb;26(2):378-81
21261730
Diabetes Metab Syndr. 2012 Apr-Jun;6(2):70-6
23153973
J Pediatr. 2007 May;150(5):461-6
17452216
BMC Gastroenterol. 2014 May 28;14:99
24885742
Pediatrics. 2009 Sep;124(3):e489-95
19706580
Arab J Gastroenterol. 2014 Jun;15(2):53-7
25097046
J Gastroenterol Hepatol. 2011 May;26(5):894-900
21182543
J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):136-60
22197856
J Pediatr. 2004 Dec;145(6):790-5
15580203
Histopathology. 2011 Aug;59(2):166-79
21054494
Indian J Endocrinol Metab. 2015 Nov-Dec;19(6):797-803
26693431
Ital J Pediatr. 2012 Mar 26;38:10
22449104
J Pediatr. 2011 Feb;158(2):276-81.e1
20817171
Diabet Med. 2012 Sep;29(9):e286-9
22672045
Diabetes Care. 2006 Nov;29(11):2452-6
17065683
Can J Diabetes. 2013 Apr;37 Suppl 1:S153-62
24070940