Endocrine Abstracts (2014) 36 P27 | DOI: 10.1530/endoabs.36.P27

Children with type 1 diabetes and coeliac disease at Nottingham Children's Hospital: a service review and evaluation

Jennifer Ashcroft, Tabitha Randell, Louise Denvir & Pooja Sachdev

Nottingham Children’s Hospital, Nottingham, Nottinghamshire, UK.

Introduction: The prevalence of coeliac disease (CD) in type 1 diabetes (T1DM) is 4.4–11.1 vs 0.5% in the general population. The compliance to gluten free diet (GFD) in symptomatic patients vs those diagnosed on screening is significantly higher as expected. The impact of untreated CD on patients with T1DM ranges from malabsorption and frequent unexplained hypoglycaemia to no symptoms.

Aims: i) To describe the demographics of our children with CD.

ii) To review compliance with GFD and to compare glycemic control and growth 1 year before and after diagnosis of CD.

Methods: Demographic details at diagnosis of CD and 1 year pre and post were retrospectively extracted from the diabetes database. A comparison was made between HbA1c, height SDS and BMI SDS at diagnosis and at 1 year pre and post to identify if the compliance with GFD was a predictor for this.

Results: 20 children (14 females) with CD (prevalence of 5.13%). Average age at CD diagnosis 7.8 years (range 3–14.8). 18/19 patients had a biopsy undertaken for diagnosis. Ten patients symptomatic at diagnosis of CD (low ferritin and abdominal pain), six diagnosed on annual review and three at T1DM diagnosis. Compliance with GFD as assessed by TTG reverting to normal was 63% at 1 year. Only 58% of patients had had their CD discussed within the MDT clinic in the last 12 months.

The height and BMI SDS was not significantly different in those compliant to a GFD, although anecdotal reports of ‘feeling well’ were documented. The HbA1c was however significantly higher and could be related to increasing duration of diabetes and the lower incidence of hypoglycaemic episodes.

1 year before CD diagnosis1 year after CD diagnosisP value (pre and post)
Height SDS−0.325−0.3030.959 (NS)
BMI SDS0.249250.4360.604 (NS)
HbA1c (mmol/mol)62.163.750.024 (S)

Conclusion: CD prevalence and compliance with GFD in our group of patients with T1DM is similar to the literature. It is important to look at how best we can address the needs of this group of YP with two chronic life-changing conditions.

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