Prevalence and Predictive Factors for Celiac Disease in Children With Type 1 Diabetes: Whom and When to Screen? A Nationwide Longitudinal Cohort Study of Swedish Children

Abstract

Objective: To examine the prevalence and predictive factors for celiac disease (CD) after a diagnosis of type 1 diabetes (T1D) in children and adolescents, to improve the current screening guidelines.

Research design and methods: The association between sex, age at T1D diagnosis, HLA, and diabetes autoantibodies, and a diagnosis of CD was examined in 5,295 children with T1D from the Better Diabetes Diagnosis study in Sweden.

Results: The prevalence of biopsy-proven CD was 9.8%, of which 58.2% already had a CD diagnosis before or at T1D onset. Almost all, 95.9%, were diagnosed with CD within 5 years after the T1D diagnosis. Younger age at the T1D diagnosis and being homozygote for DQ2 increased the risk of CD after T1D, but neither sex nor diabetes-related autoantibodies were associated with the risk.

Conclusions: Age at and time after diabetes diagnosis should be considered in screening guidelines for CD in children with T1D.

Graphical abstract

Figure 1

Flowchart of inclusion and exclusion criteria in the study population and the prevalence of CD in the different groups based on when CD is diagnosed in relation to T1D diagnosis.¹BDD, Better Diabetes Diagnosis study. ²NPR, Swedish National Patient Register. ³BDD1, children included in BDD between May 2005 and December 2010. ⁴BDD2, children included in BDD from January 2011 until December 2012.

Figure 2

Yearly incidence of CD after T1D diagnosis. “Year after T1D diagnosis” represents the year screening took place (e.g., year 0 = children screened at T1D diagnosis and CD diagnosed within the first year after T1D diagnosis, and year 1 = children screened 1 year after T1D diagnosis and CD diagnosed between the first and second year after T1D diagnosis etc.). Follow-up began at T1D diagnosis and ended at CD diagnosis, 18 years of age, or study period completion, meaning that the oldest age-groups did not have a 10-year follow-up time.