The Journal of Pediatrics
Volume 150, Issue 5 , Pages 461-466, May 2007

Impact of Celiac Autoimmunity on Children with Type 1 Diabetes

  • Jill H. Simmons, MD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • Corresponding Author InformationReprint requests: Dr Jill Simmons, 11136 Doctors’ Office Tower, 2200 Children’s Way, Nashville, TN 37232-9170.
    • ,
  • Georgeanna J. Klingensmith, MD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • ,
  • Kim McFann, PhD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • ,
  • Marian Rewers, MD, PhD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • United States Department of Preventive Medicine and Biometrics, University of Colorado, Aurora, Colorado
    • ,
  • Jennifer Taylor, MD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • ,
  • Lisa M. Emery, MSPH

      Affiliations

    • United States Department of Preventive Medicine and Biometrics, University of Colorado, Aurora, Colorado
    • ,
  • Iman Taki, BS

      Affiliations

    • United States Department of Preventive Medicine and Biometrics, University of Colorado, Aurora, Colorado
    • ,
  • Sharon Vanyi, MD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • ,
  • Edwin Liu, MD

      Affiliations

    • Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
    • Department of Pediatrics, University of Colorado Denver Health Sciences Center and The Children’s Hospital, Denver, Colorado.
    • ,
  • Edward J. Hoffenberg, MD

      Affiliations

    • Department of Pediatrics, University of Colorado Denver Health Sciences Center and The Children’s Hospital, Denver, Colorado.

Received 8 August 2006; received in revised form 24 October 2006; accepted 22 December 2006.

Objective

Children with type 1 diabetes (T1DM) are at increased risk for celiac disease (CD); however, the benefits of screening for IgA tissue transglutaminase autoantibodies (TG), a marker for CD, are unclear.

Study design

We compared 71 screening-identified TG+ with 63 matched TG– children with TIDM. Growth, bone density, and diabetes control measures were obtained.

Results

The group was 10 ± 3 years of age, 46% male, with TIDM for 4 ± 3 years. Z scores for weight (0.3 ± 1 vs 0.7 ± 0.8, P = .024), body mass index (BMI) (0.3 ± 0.9 vs 0.8 ± –0.8, P = .005), and midarm circumference (0.3 ± 1.1 vs 0.6 ± 0.9, P = .031) were lower in the TG+ group. Bone mineral density and diabetes control measures were similar. When limiting the analysis to the 35 TG+ subjects with biopsy changes of CD, the BMI Z score was lower than the control group (0.4 ± 0.9 vs 0.7 ± 0.7, P = .05).

Conclusions

In children with TIDM, screening-identified evidence of CD is associated with altered body composition, but not bone mineral density or diabetes control. Further study is needed to determine the benefit of early diagnosis and treatment of CD in TIDM children.

Abbreviations: BMI, Body mass index, CD, Celiac disease, GFD, Gluten-free diet, HbA1c, Hemoglobin A1c, IGF-I, Insulin-like growth factor I, IGF-BP3, Insulin-like growth factor binding protein 3, LBMDA, Areal lumbar bone mineral density, LBMDV, Volumetric lumbar bone mineral density, NTX, Crosslinked N-telopeptides of type I collagen, PTH, Parathyroid hormonel, T1DM, Type 1 diabetes mellitus, TG, IgA tissue transglutaminase autoantibodies, TSH, Thyroid stimulating hormone

 

 Supported by National Institutes of Health grant R01-DK50979, Autoimmunity Prevention Center grant 5U19A150864, National Institutes of Health grants DK32083, DK32493, DK63687, Autoimmunity Center of Excellence Grant U19A146374, Diabetes Endocrine Research Center P3057516, and Immune Tolerance Network Autoantibody Core Laboratory. Also supported by M01RR00069 General Clinical Research Centers Program, National Centers for Research Resources, NCRR, NIH.

PII: S0022-3476(07)00012-1

doi:10.1016/j.jpeds.2006.12.046

Refers to article:

  • Serologic Testing for Celiac Disease: Primum Non Nocere!

    Ivor Dennis Hill
    The Journal of Pediatrics May 2007 (Vol. 150, Issue 5, Pages 453-454)

The Journal of Pediatrics
Volume 150, Issue 5 , Pages 461-466, May 2007

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