Clinical Manifestations of Celiac Disease in Children with Type 1 Diabetes Mellitus- An Institutional Experience from Southern India

Abstract

Introduction: The prevalence of Celiac Disease (CD) is known to be significantly higher in children with Type1 Diabetes (T1DM) as compared to the general population. Non-gastrointestinal symptoms are predominant manifestations of CD in these children. Aim: To estimate the prevalence of CD in children with T1DM and to assess the clinical presentation of CD in them. Materials and Methods: Data was collected retrospectively from the medical records of children with T1DM who were treated in a Paediatric endocrinology unit of a tertiary referral centre between January 2012 to December 2015 and screened for CD with Anti Tissue Transglutamase (ATTG) test. ATTG >15 U/mL was considered positive and Marsh criteria used for duodenal biopsy classification. The clinical manifestations of CD were analysed. Descriptive statistics (mean, standard deviation) were used to summarise the study variables. Results: Among the 152 children screened for CD, 18.4% (28) were positive for celiac serology and 78.5% (11) of the 14 children who underwent duodenal biopsy had mucosal changes. Unexplained asymptomatic hypoglycaemia, poor glycaemic control, and growth retardation were the most common indications for screening CD. Conclusion: This study emphasises that gastrointestinal symptoms of CD may be minimal in diabetic children and recognition of non-gastrointestinal symptoms helps in early detection. If resources permit universal screening for CD is recommended in T1DM children.

Keywords

• anti-tissue transglutamase
• celiac disease screening
• gluten free diet