Impact of Celiac Autoimmunity on Children with Type 1 Diabetes

Department of Pediatrics, University of Colorado, Denver, Colorado, United States
The Journal of pediatrics (Impact Factor: 3.79). 06/2007; 150(5):461-6. DOI: 10.1016/j.jpeds.2006.12.046
Source: PubMed


Children with type 1 diabetes (T1DM) are at increased risk for celiac disease (CD); however, the benefits of screening for IgA tissue transglutaminase autoantibodies (TG), a marker for CD, are unclear.
We compared 71 screening-identified TG+ with 63 matched TG- children with TIDM. Growth, bone density, and diabetes control measures were obtained.
The group was 10 +/- 3 years of age, 46% male, with TIDM for 4 +/- 3 years. Z scores for weight (0.3 +/- 1 vs 0.7 +/- 0.8, P = .024), body mass index (BMI) (0.3 +/- 0.9 vs 0.8 +/- -0.8, P = .005), and midarm circumference (0.3 +/- 1.1 vs 0.6 +/- 0.9, P = .031) were lower in the TG+ group. Bone mineral density and diabetes control measures were similar. When limiting the analysis to the 35 TG+ subjects with biopsy changes of CD, the BMI Z score was lower than the control group (0.4 +/- 0.9 vs 0.7 +/- 0.7, P = .05).
In children with TIDM, screening-identified evidence of CD is associated with altered body composition, but not bone mineral density or diabetes control. Further study is needed to determine the benefit of early diagnosis and treatment of CD in TIDM children.

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Available from: Edward J Hoffenberg, Jun 10, 2014
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    • "A review of the recent primary literature demonstrated that in those health services that practise routine serological screening for CD in people with T1DM, anthropometry and growth parameters were reported to be within the normal reference values at the time of CD diagnosis [7,11-14] (Additional file 1: Table S1). However children with dual diagnosis did not grow as well as their T1DM peers, [7,15] presenting with greater deficits in weight [7,15,16], height [16,17] and BMI z-scores [15,16]. In contrast, in two studies in centres without regular screening, growth and nutritional status deficits were more pronounced in children with T1DM + CD [16,17] (Additional file 1: Table S1). "
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    ABSTRACT: Background The consequences of subclinical coeliac disease (CD) in Type 1 diabetes mellitus (T1DM) remain unclear. We looked at growth, anthropometry and disease management in children with dual diagnosis (T1DM + CD) before and after CD diagnosis. Methods Anthropometry, glycated haemoglobin (HbA1c) and IgA tissue transglutaminase (tTg) were collected prior to, and following CD diagnosis in 23 children with T1DM + CD. This group was matched for demographics, T1DM duration, age at CD diagnosis and at T1DM onset with 23 CD and 44 T1DM controls. Results No differences in growth or anthropometry were found between children with T1DM + CD and controls at any time point. Children with T1DM + CD, had higher BMI z-score two years prior to, than at CD diagnosis (p < 0.001). BMI z-score change one year prior to CD diagnosis was lower in the T1DM + CD than the T1DM group (p = 0.009). At two years, height velocity and change in BMI z-scores were similar in all groups. No differences were observed in HbA1c between the T1DM + CD and T1DM groups before or after CD diagnosis. More children with T1DM + CD had raised tTg levels one year after CD diagnosis than CD controls (CDx to CDx + 1 yr; T1DM + CD: 100% to 71%, p = 0.180 and CD: 100% to 45%, p < 0.001); by two years there was no difference. Conclusions No major nutrition or growth deficits were observed in children with T1DM + CD. CD diagnosis does not impact on T1DM glycaemic control. CD specific serology was comparable to children with single CD, but those with dual diagnosis may need more time to adjust to gluten free diet.
    BMC Gastroenterology 05/2014; 14(1):99. DOI:10.1186/1471-230X-14-99 · 2.37 Impact Factor
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    • "Most studies reported lower BMD in CA+ T1DM except the one by Simmons et al., where the results may be biased due to the healthy volunteer effect [15–17]. The additive BMD lowering effect of CD may be due to the underlying inflammatory state increasing bone resorption, malabsorption and increased nutritional deficiencies, associated hypogonadism, and GH resistance [16]. "
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    ABSTRACT: Type 1 diabetes mellitus (T1DM) has been inconsistently associated with low bone mineral density (BMD) and increased fracture risk. 86 consecutive T1DM cases and 140 unrelated age and sex matched healthy nondiabetic controls were included in the study. After history and examination, BMD and body composition were assessed by dual energy X-ray absorptiometry (DXA). Serum samples were analyzed for calcium, phosphorus, albumin, creatinine, alkaline phosphatase, 25 (OH) vitamin D3, intact parathormone (PTH) levels (both cases and controls) and HbA1c, antimicrosomal and IgA tissue transglutaminase (IgA TTG) antibodies, cortisol, follicle stimulating hormone (FSH), testosterone, sex hormone binding globulin (SHBG), tetraiodothyronine (T4), thyroid stimulating hormone (TSH), growth hormone (GH), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein 3 (IGFBP3) (cases only). T1DM cases had a lower BMD as compared to controls at both total body (TB) and lumbar spine (LS) (P < 0.05). Patients with celiac autoimmunity (CA) had significantly, lower BMD as compared to age, sex, and body mass index (BMI) matched T1DM controls. Linear regression analysis showed that low BMD in T1DM patients was associated with poor glycaemic control, lower IGF-1 levels, less physical activity (in total population as well as in male and female subgroups), and lower body fat percentage (in females) and higher alkaline phosphatase level (in males) (P < 0.05).
    Journal of Osteoporosis 03/2013; 2013(6):397814. DOI:10.1155/2013/397814
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    • "Similarly, children with T1D with evidence of symptomatic CD benefit from GFD (Hansen et al., 2006; Saadah et al., 2004); in symptom-free cases the demonstrated benefit is limited to weight gain and bone mineral density (BMD) changes.( Artz et al., 2008; Rami et al., 2005; Simmons et al., 2007). Recently a 2-year prospective follow up study has provided additional evidence that only in some of the children with T1D and few classical symptoms of CD, identified by screening as being TG+ present, the demonstrated benefit of GFD is limited to weight gain and BMD changes (Simmons et al., 2011); moreover, other authors have reported an improved glycemic control in GFD-compliant celiac patients (Sanchez- Albisua et al., 2005). "
    Type 1 Diabetes Complications, 11/2011; , ISBN: 978-953-307-788-8
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