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Diabetes Care. 2015 May;38(5):760-6. doi: 10.2337/dc14-2890. Epub 2015 Mar 17.

High rate of spontaneous normalization of celiac serology in a cohort of 446 children with type 1 diabetes: a prospective study.

Author information

1
Department of Pediatrics, San Paolo Hospital, Bari, Italy scastellaneta@libero.it.
2
Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy.
3
Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy.
4
Department of Paediatrics, University Politecnica delle Marche, Ancona, Italy.
5
Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy.

Abstract

OBJECTIVE:

In children with type 1 diabetes mellitus (T1DM), elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize, despite continued consumption of gluten. We aimed to investigate the prevalence of spontaneous normalization of anti-tTG levels and the existence of factors predictive for this outcome.

RESEARCH DESIGN AND METHODS:

All children referred from 2002 to 2012 were screened for celiac disease (CD) at diabetes onset and at specific intervals. In the presence of a high anti-tTG titer or clinical symptoms, children were offered endoscopy, and asymptomatic patients with a low anti-tTG titer were invited to a second serological test after 6 months of eating a gluten-containing diet.

RESULTS:

The study included 446 children. Of these, 65 (14.5%) became positive for celiac serology: 38 (58%) had a persistently elevated anti-tTG titer and 27 (41%) fluctuating anti-tTG titer; 18 (28%) became negative. The prevalence of positive CD autoimmunity and overt CD was 14.3% (95% CI 11-17) and 8.5% (95% CI 5-10), 15- and 8-times higher than the general pediatric population, respectively. Asymptomatic children older than 9.1 years at T1DM onset had the lowest risk to develop CD.

CONCLUSIONS:

Serum anti-tTG levels decreased spontaneously in 40% of children with T1DM and became negative in 20%, despite gluten consumption. This finding supports the hypothesis of a state of temporary positivity of celiac serology in children with diabetes. In absence of clinical symptoms or signs of CD, histological confirmation of the disease and the gluten-free diet should be postponed to avoid unnecessary procedures and reduce an additional psychological burden.

PMID:
25784659
DOI:
10.2337/dc14-2890
[Indexed for MEDLINE]

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