Children with type 1 diabetes should be screened for coeliac disease early and regularly, according to the findings of an international study.
The cross-sectional study of more than 52,000 children with diabetes in Europe, the US and Australia found younger children were at a particularly high risk of the autoimmune disease.
The study found the mean age of diagnosis with diabetes in children with both diseases was 5.4 years compared to 7.0 years for children with diabetes alone.
A diagnosis of coeliac disease predated the diabetes diagnosis in 5% of patients and occurred in the first year after the diabetes diagnosis in 37% of patients.
A further 18% were diagnosed with coeliac disease in the first 2 years after a diabetes diagnosis, 23% during year 3-5 of diabetes and 17% after more than five years with diabetes.
Coauthor Professor Maria Craig, paediatric endocrinologist at The Children’s Hospital at Westmead, told the limbic the variability in the time of onset of coeliac disease was as reminder to clinicians to keep screening.
“The group of children with type 1 diabetes at age five years or under need to be screened for comorbidities and complications. All guidelines recommend doing both but there is not great consensus on how often to screen,” she said.
The study also said that screening should be universal irrespective of ethnicity given increasing rates of coeliac disease in non-Caucasian populations traditionally thought to be at low risk.
Professor Craig said HbA1c levels were relatively consistent between patients with both coeliac disease and diabetes and those with diabetes alone (8.3 v 8.4%). However only 31% of patients achieved the international target of <7.5%.
“The good news for parents is that coeliac disease doesn’t appear to worsen their children’s blood glucose control however we still have a long way to go to get all those HbA1c levels down.”
The study also found a modest but significant difference in height between the two groups of children with lower height in children with both diseases.
“I do think it should be taken seriously. While not a major height deficit, it does suggest coeliac disease may impact on growth.”
She said taken together with other evidence that coeliac disease in the general population influences height, and that nutritional intake is often inadequate in young people with diabetes, with or without coeliac disease, the findings suggested the need for care with nutrition.
The study found biopsy-confirmed coeliac disease in 3.5% of children with diabetes overall and more common in girls than boys (4.3 v 2.7%).