Prevalence of celiac disease in 52,721 youth with type 1diabetes: International comparison across three continents

Maria E. Craig, Nicole Prinz, Claire T. Boyle, Fiona M. Campbell, Timothy W. Jones, Sabine E. Hofer, Jill H. Simmons, Naomi Holman, Elaine Tham, Elke Fröhlich-Reiterer, Stephanie DuBose, Helen Thornton, Bruce King, David M. Maahs, Reinhard W. Holl, Justin T. Warner

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OBJECTIVE Celiac disease (CD) has a recognized association with type 1 diabetes.We examined international differences in CD prevalence and clinical characteristics of youth with coexisting type 1 diabetes and CD versus type 1 diabetes only. RESEARCH DESIGN AND METHODS Data sources were as follows: the Prospective Diabetes Follow-up Registry (DPV) (Germany/Austria); the T1D Exchange Clinic Network (T1DX) (U.S.); the National Paediatric Diabetes Audit (NPDA) (U.K. [England/Wales]); and the Australasian Diabetes Data Network (ADDN) (Australia). The analysis included 52,721 youths <18 years of age with a clinic visit between April 2013 and March 2014. Multivariable linear and logistic regression models were constructed to analyze the relationship between outcomes (HbA1c, height SD score [SDS], overweight/obesity) and type 1 diabetes/CD versus type 1 diabetes, adjusting for sex, age, and diabetes duration. RESULTS Biopsy-confirmed CD was present in 1,835 youths (3.5%) and was diagnosed at a median age of 8.1 years (interquartile range 5.3-11.2 years). Diabetes duration at CD diagnosis was <1 year in 37% of youths, 1-2 years in 18% of youths, 3-5 years in 23%of youths, and 5 years in 17%of youths. CD prevalence ranged from1.9%in the T1DX to 7.7%in the ADDNand was higher in girls than boys (4.3%vs. 2.7%, P < 0.001). Children with coexisting CDwere younger at diabetes diagnosis compared with those with type 1 diabetes only (5.4 vs. 7.0 years of age, P < 0.001) and fewer were nonwhite (15 vs. 18%, P < 0.001). Height SDS was lower in those with CD (0.36 vs. 0.48, adjusted P < 0.001) and fewer were overweight/obese (34 vs. 37%, adjusted P < 0.001),whereasmeanHbA1c valueswere comparable: 8.361.5%(67617mmol/mol) versus 8.4 6 1.6% (68 6 17 mmol/mol). CONCLUSIONS CD is a common comorbidity in youth with type 1 diabetes. Differences in CD prevalence may reflect international variation in screening and diagnostic practices, and/ or CD risk. Although glycemic control was not different, the lower height SDS supports close monitoring of growth and nutrition in this population.

Original languageEnglish
Pages (from-to)1034-1040
Number of pages7
JournalDiabetes Care
Issue number8
Publication statusPublished - 1 Aug 2017

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    Craig, M. E., Prinz, N., Boyle, C. T., Campbell, F. M., Jones, T. W., Hofer, S. E., Simmons, J. H., Holman, N., Tham, E., Fröhlich-Reiterer, E., DuBose, S., Thornton, H., King, B., Maahs, D. M., Holl, R. W., & Warner, J. T. (2017). Prevalence of celiac disease in 52,721 youth with type 1diabetes: International comparison across three continents. Diabetes Care, 40(8), 1034-1040.