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J Pediatr. 2011 Feb;158(2):276-81.e1. doi: 10.1016/j.jpeds.2010.07.025.

Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up.

Author information

  • 1Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt Children's Hospital, Nashville, TN, USA. jill.h.simmons@vanderbilt

Abstract

OBJECTIVE:

To determine the benefits of screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibodies (TG) in children with type 1 diabetes (T1D).

STUDY DESIGN:

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.

Copyright © 2011 Mosby, Inc. All rights reserved.

Comment in

  • To test or not to test…this is the problem. [J Pediatr. 2011]
PMID:
20817171
[PubMed - indexed for MEDLINE]
PMCID:
PMC2999645
Free PMC Article
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