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Meta-Analysis
. 2019 Jul;40(7):647-656.
doi: 10.15537/smj.2019.7.24293.

Celiac disease in type 1 diabetes mellitus in the Kingdom of Saudi Arabia. Characterization and meta-analysis

Mohammad Ayman Safi  1
Affiliations
Meta-Analysis

Celiac disease in type 1 diabetes mellitus in the Kingdom of Saudi Arabia. Characterization and meta-analysis

Mohammad Ayman Safi. Saudi Med J. 2019 Jul.

Abstract

To characterize and meta-analyze the pertinent studies concerning celiac disease (CD) among patients with type 1 diabetes mellitus (T1DM) in the Kingdom of Saudi Arabia. Methods: Data (from the relevant articles) were analyzed using both the Statistical Package for Social Sciences, version 20 (IBM Corp., Armonk, NY, USA) program and the comprehensive meta-analysis (CMA) program. This study was conducted between March and July 2018 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Written ethical approval was not obtained because this study was a retrospective literature review and analysis. Results: The prevalence of seropositive-CD was 15.88% with high heterogeneity (I2=84.0), while the prevalence of biopsy-proven CD was 12% with high heterogeneity (I2=82.7). Anti-transglutaminase was used in 7 of the 8 studies; alone in 4; with endomysial antibodies in 2; and with antigliadin antibodies (AGA) in one. In the remaining study, antireticulin antibodies was used with AGA. The age of the involved patients ranged from 8 months to 50 years old. Conclusion: The prevalence of biopsy-proven CD among T1DM patients in Kingdom of Saudi Arabia (12.0%) was double the global prevalence (6.0%), and much higher than the normal Saudi population (1.4%). The female-to-male ratio (2:1) of CD patients in T1DM was the same as in the normal population in Kingdom of Saudi Arabia. No significant difference was detected between the reported serologically-proven rates and the reported biopsy-proven rates (p=0.093).

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Figures

Figure 1
Figure 1
PRISMA flow-diagram showing the selection process of the pertinent studies. CD- celiac diseases, KSA - Kingdom of Saudi Arabia, T1DM - type 1 diabetes mellitus.
Figure 2
Figure 2
Sample size and prevalence (seropositivity rate and biopsy-proven rate) of celiac disease among type 1 diabetes mellitus patients in the retrieved studies. Al-Ashwal AA et al 2003 (1), Saadah OI et al 2004 (2), Al-Hussaini A et al 2012 (3), Saadah OI et al 2012 (4), Al-Agha AE et al 2015 (5), Al-Hakami AM 2016 (6), Alshareef MA et al 2016 (only seropositivity rate) (7), Alghamdi RA et al 2018 (only seropositivity rate) (8).
Figure 3
Figure 3
Seroprevalence (by fixed and random models) with statistics and relative weight for each study.
Figure 4
Figure 4
Forest plot for prevalence of seropositive celiac diseases among type one diabetes mellitus in the Kingdom of Saudi Arabia.
Figure 5
Figure 5
Prevalence of biopsy-proven CD (by fixed and random models) with statistics and relative weight for each study. CD- celiac diseases, KSA - Kingdom of Saudi Arabia, T1DM - type 1 diabetes mellitus.
Figure 6
Figure 6
Forest plot for prevalence of biopsy-proven celiac disease among type 1 diabetes mellitus in Saudi Arabia. CI - confidence interval
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