Introduction: Celiac disease (CD) is a common condition in children with type 1 diabetes (T1D). This condition is often asymptomatic and predisposes to severe complications of diabetes. The aim of this work was to study the clinical, biological, and evolutionary features of CD in diabetic children compared to a control group of non-celiac diabetic children.
Patients and methods: Retrospective study of a cohort of 10 T1D children with CD compared to a control group of 20 non-celiac diabetic children collected in the Pediatric Department of Tahar Sfar University Hospital of Mahdia over 30 years.
Results: The prevalence of CD in children with diabetes was 2.7%. Diabetes was revealed in celiac children by ketoacidosis in 70% of cases versus 40% in controls. The mean duration of diabetes progression was 8.6±1.8 years in celiac patients versus 10.2±2.1 years in controls. The mean age of discovery of CD was 7.8±3.1 years, 3.6 years in mean after the discovery of diabetes with a sex ratio of 1.5. At the time of diagnosis of CD, 50% of children were asymptomotic, 40% had growth delay, 14% had abdominal pain, 14% recurrent hypoglycaemia, 7% chronic diarrhea, 60% anemia, and 70% CD positive antibodies. Jejunal biopsies showed total villous atrophy in 40% of cases, subtotal villous atrophy in 30% of cases and partial villous atrophy in 30% of cases. Gastric biopsy revealed associated Helicobacter pylori gastritis in 50% of cases. After initiating a gluten-free diet, 60% of celiac children had poor diet adherence because of their low socioeconomic status. Short stature was observed in 50% of celiac patients versus 15% of controls. Hypoglycemia was a cause of re-hospitalization twice as common in celiac children than in the control group. Mean HbA1C in celiac patients was 10.4% versus 9.1% in controls.
Conclusion: This study confirms the high prevalence of CD in children with T1D who are prone to severe comorbidities and who are generally poorly adherent to the gluten-free diet. Serologic screening for CD allows early diagnosis and management to improve the balance in diabetes and avoid complications.
18 - 21 May 2019
European Society of Endocrinology