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

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.

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  • Authors+Show Affiliations

    ,

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

    , , , , , ,

    Source

    The Journal of pediatrics 158:2 2011 Feb pg 276-81.e1

    MeSH

    Adolescent
    Age Distribution
    Autoimmunity
    Biopsy, Needle
    Case-Control Studies
    Celiac Disease
    Child
    Diabetes Mellitus, Type 1
    Diet, Gluten-Free
    Female
    Follow-Up Studies
    Humans
    Immunoglobulin A
    Immunohistochemistry
    Incidence
    Male
    Mass Screening
    Reference Values
    Risk Assessment
    Sex Distribution
    Time Factors
    Transglutaminases

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    20817171

    Citation

    Simmons, Jill H., et al. "Celiac Autoimmunity in Children With Type 1 Diabetes: a Two-year Follow-up." The Journal of Pediatrics, vol. 158, no. 2, 2011, pp. 276-81.e1.
    Simmons JH, Klingensmith GJ, McFann K, et al. Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up. J Pediatr. 2011;158(2):276-81.e1.
    Simmons, J. H., Klingensmith, G. J., McFann, K., Rewers, M., Ide, L. M., Taki, I., ... Hoffenberg, E. J. (2011). Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up. The Journal of Pediatrics, 158(2), pp. 276-81.e1. doi:10.1016/j.jpeds.2010.07.025.
    Simmons JH, et al. Celiac Autoimmunity in Children With Type 1 Diabetes: a Two-year Follow-up. J Pediatr. 2011;158(2):276-81.e1. PubMed PMID: 20817171.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up. AU - Simmons,Jill H, AU - Klingensmith,Georgeanna J, AU - McFann,Kim, AU - Rewers,Marian, AU - Ide,Lisa M, AU - Taki,Iman, AU - Liu,Edwin, AU - Hoffenberg,Edward J, PY - 2009/11/02/received PY - 2010/06/09/revised PY - 2010/07/16/accepted PY - 2010/9/7/entrez PY - 2010/9/8/pubmed PY - 2011/2/25/medline SP - 276 EP - 81.e1 JF - The Journal of pediatrics JO - J. Pediatr. VL - 158 IS - 2 N2 - 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. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/20817171/Celiac_autoimmunity_in_children_with_type_1_diabetes:_a_two_year_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(10)00603-7 DB - PRIME DP - Unbound Medicine ER -