Celiac disease and type 1 diabetes: To screen or not to screen?

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Several groups have recommended that subjects with type I diabetes (T1DM) undergo screening for celiac disease (CD). In fact, serological screening for CD will yield positive markers in 10-15% of children with T1DM. However, because the vast majority of these individuals are asymptomatic, the question arises as to the value of screening and the benefit of early detection of CD. The long-term outcome for untreated, asymptomatic patients with CD, with or without T1DM, is not known. On the other hand, the contribution of variable nutrient intake and absorption due to concomitant CD on complications of T1DM (decreased bone mineral density, reduced growth, poor diabetic control) must be addressed.

Simmons et al evaluated the impact of screening-identified CD on growth, bone mineral density, and the course of diabetes. Weight, BMI, and anthropometric measures were reduced in patients with T1DM who were CD positive. There were no differences in height, bone mineral density, or in diabetes control indices.

In an editorial, Ivor Hill discusses the possible benefit of screening balanced against the negative impact and unintended consequences. It may be time to rethink the recommendations and to assess the true value of screening for CD in asymptomatic patients with T1DM.