title: Coeliac patients detected during type 1 diabetes surveillance had similar issues to those diagnosed on a clinical basis.
abstract: OBJECTIVE
  Screening children with type 1 diabetes for coeliac disease is controversial, because they often appear asymptomatic. Our aim was to establish whether active screening should be recommended.
  
  
  METHODS
  This study focused on 22 children whose coeliac disease was detected by serological screening during diabetes surveillance and 498 children diagnosed because of a clinical suspicion. We compared the clinical and histological data at diagnosis and the children's adherence and responses to a gluten-free diet.
  
  
  RESULTS
  The serological screening group suffered less from decreased growth (p = 0.016) and clinical symptoms (p < 0.001) at diagnosis than the clinical group. The groups did not differ in terms of age at diagnosis (p = 0.903), gender (p = 0.353), anaemia (p = 0.886), endomysial antibody titres (p = 0.789) and the severity of small-bowel mucosal atrophy (p = 0.104). They also showed equal adherence (p = 0.086) and clinical responses (p = 0.542) to a gluten-free diet after a median follow-up of 13 months.
  
  
  CONCLUSIONS
  Coeliac patients detected during diabetes surveillance had signs of malabsorption and advanced mucosal damage that was similar to those diagnosed on a clinical basis. They often suffered from unrecognised gluten-dependent symptoms and showed excellent adherence and responses to a gluten-free diet. Our findings support active screening for coeliac disease in patients with type 1 diabetes.
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Anna U
authors.initials: AU
authors.lastname: Laitinen
authors.affiliation: The Diabetes and Celiac Disease Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Agardh
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Kivelä
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Lähdeaho
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.affiliation: Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening
keywords: Clinical diagnosis; Coeliac disease; Routine surveillance; Type 1 diabetes; Villous atrophy