Retrospective evaluation of TYPE 1 diabetes and celiac combination in children

Introduction: In patients with type 1 diabetes mellitus (T1DM), the frequency of celiac disease (CD) has increased, as is the increase in other autoimmune diseases compared to the normal population. The prevalence of CD in the general population is estimated to be between 0.3% and 1%. However, it has been reported that the prevalence of CD varies between 1% and 10% in children and adolescents due to a common genetic predisposition in patients with T1DM. In this study, it was aimed to determine the frequency of CD development at the time of diagnosis and during follow-up, and to evaluate the effect of CD on growth and metabolic control in patients with T1DM who were diagnosed with T1DM in our hospital and were followed up regularly. Methods: A total of 424 patients aged 1-18 years who were followed up with the diagnosis of T1DM between January 2013 and September 2021 were included in the study. Of these 424 patients, the data of 338 patients whose celiac serology was studied were evaluated retrospectively. Age, gender, and mean HbA1c levels of the patients were recorded during the follow-up period. Body weight (VA) standard deviation score (SDS), height and body mass index (BMI) SDS scores of the patients were calculated both at the time of diagnosis of T1DM and at the last admission. The biopsy results of the patients whose anti-tissue transglutaminase IgA (anti-DTG IgA) levels were checked and positive were recorded. In addition, cases whose anti-DTG IgA levels improved spontaneously were also recorded. It was checked whether thyroid autoantibodies were checked in the patients in the study. Results: Of the 424 patients included in the study, 222 (52.4%) were male and 202 (47.6%) were female, and the mean age of the patients at the time of the study was 13.99 ± 4.9 years. The mean age at diagnosis of T1DM was 9.33 ± 4.39 years and the mean duration of DM was 4.63 ± 3 years. While 19.3% of the patients in the study were under the age of 5, 80.7% were over the age of 5. Celiac serology was negative in 288 (85.2%) of 338 patients whose anti-DTG IgA levels were measured, while celiac serology was positive in 50 (14.8%) of them. Spontaneous recovery was observed in 22 (44%) of 50 patients with positive autoantibody positivity, in an average of 22.7 (4-65) months. Small intestinal biopsy was performed in 15 (53.6%) of the remaining 28 patients, and findings consistent with CD were found in 14 of them. A diagnosis of biopsy-proven celiac disease (BPCD) was made in 14 (4.1%) of 338 patients whose celiac antibody levels were measured. In the study, 8 (57.1%) of 14 patients diagnosed with BPCD were male, while 6 (42.9%) were female. In the study, serological positivity was found in 68% of the patients with positive celiac serology at the time of diagnosis of T1DM, 30% within the first 5 years after the age of diagnosis of T1DM, and 2% after 9.3 years after the age of diagnosis of DM. In the study, no significant difference was found between the celiac-negative group and the group with BPCD, both at the time of diagnosis of DM and at the last admission in terms of VA, height, and BMI SDS scores. Mean HbA1c levels were not different between the two groups. There was no significant difference between the VA, height and BMI SDS scores of the group with BPCD both at diagnosis and at the last admission. In patients with T1DM, no significant correlation was found between the age at diagnosis of DM, gender, the presence of Hashimoto's and CD. As a result; In our study, serological celiac positivity was detected in 15.8% of our patients with T1DM, while the frequency of BPCD was determined as 4.1%. Of the patients with celiac antibody positivity, 68% were detected at the time of diagnosis of T1DM, and 98% within the first 5 years after the diagnosis age of T1DM. The presence of Hashimoto's thyroiditis or the small age at diagnosis of T1DM (<5 years) in patients with type 1 DM were not found to be associated with CD risk. Anthropometric measurements and mean HbA1c levels of the groups with and without celiac disease were not different. It was found that 44% of the cases with celiac antibody positivity returned to normal spontaneously in about 2 years, despite the gluten-free diet. For this reason, we recommend serological follow-up instead of immediate duodenal biopsy or gluten-free diet therapy for all patients with celiac antibody positivity, especially those who are asymptomatic. Keywords: Type 1 DM, celiac disease, Children.