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Kamrath C, Tittel SR, Dunstheimer D, Fröhlich-Reiterer E, Freff M, Böttcher C, Scheffler N, Lenze S, Gericke E, Thiele S, Holl RW. Early vs late histological confirmation of coeliac disease in children with new-onset type 1 diabetes. Diabetologia 2022; 65:1108-1118. [PMID: 35488926 PMCID: PMC9174128 DOI: 10.1007/s00125-022-05701-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/11/2022] [Indexed: 11/26/2022]
Abstract
AIM Screening for coeliac disease in asymptomatic children with new-onset type 1 diabetes is controversial. The aim of this study was to analyse whether the confirmation of coeliac disease in children with new-onset type 1 diabetes and positive screening results can be postponed. METHODS This was a multicentre population-based cohort study based on the German/Austrian/Swiss/Luxembourgian Prospective Diabetes Follow-up Registry (Diabetes Patienten Verlaufsdokumentation [DPV]). Participants aged ≤18 years diagnosed with type 1 diabetes between 1995 and June 2021 and with elevated IgA tissue transglutaminase antibodies (anti-tTGA) at diabetes onset on screening for coeliac disease were included. We compared outcomes of participants with a diabetes duration of more than 1 year between those in whom coeliac disease was confirmed histologically within the first 6 months and those in whom coeliac disease was confirmed between 6 and 36 months after diabetes diagnosis. RESULTS Of 92,278 children and adolescents with a diagnosis of type 1 diabetes, 26,952 (29.2%) had documented anti-tTGA data at diabetes onset. Of these, 2340 (8.7%) had an elevated anti-tTGA level. Individuals who screened positive were younger (median age 9.0 vs 9.8 years, p<0.001) and more often female (53.1% vs 44.4%, p<0.001). A total of 533 participants (22.8% of those who screened positive) had a documented biopsy, of whom 444 had documented histological confirmation of coeliac disease. Of 411 participants with biopsy-proven coeliac disease within the first 36 months of diabetes and follow-up data, histological confirmation was performed in 264 (64.2%) within the first 6 months and in 147 (35.8%) between 6 and 36 months after diabetes onset. At follow-up (median diabetes duration 5.3 years and 5.1 years, respectively), estimated median HbA1c levels (62.8 mmol/mol vs 62.2 mmol/mol [7.9% vs 7.8%]), cardiovascular risk markers (lipids, rate of microalbuminuria, blood pressure), rates of acute diabetes complications (diabetic ketoacidosis, severe hypoglycaemia) and the proportions of participants reaching anti-tTGA levels within the normal range did not differ between groups. Participants with delayed histological confirmation of coeliac disease showed no negative effects on growth or weight gain during the observation period. CONCLUSIONS Our study suggests that the histological confirmation of coeliac disease in asymptomatic individuals with new-onset type 1 diabetes could be postponed.
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Affiliation(s)
- Clemens Kamrath
- Division of Paediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry (ZIBMT), Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Desiree Dunstheimer
- Division of Paediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, University Children's Hospital Augsburg, Augsburg, Germany
| | - Elke Fröhlich-Reiterer
- Department of Paediatrics and Adolescent Medicine, Division of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Markus Freff
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Claudia Böttcher
- Paediatric Endocrinology and Diabetology, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Nadine Scheffler
- Centre for Paediatrics and Adolescent Medicine, Neonatology and Paediatric Intensive Care, Clinic Itzehoe, Itzehoe, Germany
| | - Stefanie Lenze
- Centre of Diabetes, Department of Paediatrics, Sana Klinikum Berlin Lichtenberg, Berlin, Germany
| | - Elke Gericke
- Centre of Child and Adolescent Medicine, Mathias-Spital Rheine, Rheine, Germany
| | - Susanne Thiele
- Centre of Diabetes, Hospital of Child and Adolescent Medicine, St Vincenz Hospital, Paderborn, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Oliveira DR, Rebelo JF, Maximiano C, Gomes MM, Martins V, Meireles C, Antunes H, Martins S. HLA DQ2/DQ8 haplotypes and anti-transglutaminase antibodies as celiac disease markers in a pediatric population with type 1 diabetes mellitus. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:229-236. [PMID: 35420265 PMCID: PMC9832899 DOI: 10.20945/2359-3997000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Evaluate the celiac disease (CD) markers, within the scope of its screening, in a pediatric population with diagnosis of type 1 diabetes (T1D) at Hospital de Braga (HB) and determine the prevalence of CD in the sample. Reflect on CD screening algorithm applied in this pediatric population. Methods Retrospective observational study with 94 patients diagnosed with T1D at age 10 years or younger, followed up at the HB Outpatient Diabetology Consultation, including those referred from other hospitals. Record of clinical information, IgA anti-transglutaminase and anti-endomysium and HLA DQ2/DQ8 haplotypes. Results We obtained positive serological test for CD in 4 patients. This test had 100% sensitivity and specificity. The prevalence of CD was 4.3% (n = 4). Positive HLA screening in 84.6% of patients, with both sensitivity and negative predictive value of 100% and specificity of 16.67%. Diagnosis of CD was made on average 3.40 ± 3.32 years after the diagnosis of TD1. All cases of CD registered non-gastrointestinal manifestations, none had gastrointestinal symptoms. Conclusion This study proved that there is a higher prevalence of CD in pediatric population with TD1, when compared to general population, and clarified the importance of CD screening. Furthermore, it was observed that serological screening for CD antibodies is an excellent screening test and HLA typing, although not the most suitable first line test, can be useful in excluding the possibility of patients with T1D developing CD.
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Affiliation(s)
| | | | | | - Maria Miguel Gomes
- Faculdade de Medicina da Universidade do Minho, Braga, Portugal.,Unidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Hospital de Braga, Braga, Portugal
| | - Vânia Martins
- Serviço de Pediatria, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Carla Meireles
- Serviço de Pediatria, Hospital Senhora da Oliveira-Guimarães, Guimarães, Portugal
| | - Henedina Antunes
- Unidade de Gastroenterologia, Hepatologia e Nutrição, Serviço de Pediatria e Centro Académico Clínico Hospital de Braga, Braga, Portugal.,Instituto de Investigação em Ciências da Vida e da Saúde (ICVS), ICVS/3B's-PT Laboratório Associado do Governo e Faculdade de Medicina da Universidade do Minho, Braga, Portugal
| | - Sofia Martins
- Unidade de Endocrinologia e Diabetologia Pediátrica, Departamento de Pediatria, Hospital de Braga, Braga, Portugal
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Ibaid I, Hussien M, Kaukinen K, Sabir O, Elmekki M, Musa A, Abdelhadi N, El Hussein AR, Saavalainen P. Role of HLA-DQ typing and antitissue transglutaminase antibody titres in diagnosing coeliac disease among Sudanese children with type 1 diabetes mellitus. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000735. [PMID: 35074908 PMCID: PMC8788197 DOI: 10.1136/bmjgast-2021-000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of the study was to determine the prevalence of coeliac disease (CD) and to recognise Human leukocyte antigen (HLA)-associated hereditary susceptibility to Sudanese CD patients with type 1 diabetes mellitus (DM1). Design Antitissue transglutaminase IgA (anti-TG IgA) was measured in the serum of 373 children affected with DM1 aged 1–19-year old and in 100 serum samples from non-diabetic control children. Histological examination was performed in 19 children seropositive for anti-TG IgA (17 DMI and 2 controls). Additionally, PCR-based analysis of Major histocompatibility complex, class II, DQ beta 1 (HLA-DQB1) genotyping was implemented in three study population groups as follows: group 1 (n=25) (+ve DM1 and +ve CD), group 2 (n=63) (-ve DM1 and +ve CD) and control group 3 (n=2) (+ve CD). Results Twenty-six Sudanese children with DM1 out of 373 (6.97%) were seropositive for anti-TG IgA. Duodenal biopsy revealed Marsh 2 and 3 in 13 out of 17 (76.47%) seropositive anti-TG IgA patients with DM1. Significant association (p<0.05) was detected between the level of anti-TG IgA autoantibodies (IU/mL) and Marsh stage. HLA DQ2 and DQ8 were found in 88% (22/25) and 8% (2/25) of examined patients with CD with DM1, respectively. Conclusions Anti-TG IgA titre of greater than 10 times upper limit of normal (≥10× ULN) can be useful for detecting CD in children with type 1 diabetes without duodenal biopsy. HLA testing in children with DM1 appears to provide little added benefit given the high prevalence (96%) of HLA DQ2/DQ8 in children with DM1.
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Affiliation(s)
- Ibtihag Ibaid
- Department of Microbiology, Central laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Mohammed Hussien
- Department of Microbiology, Central laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Katri Kaukinen
- Coeliac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Omayma Sabir
- Al Nileen Medical School, Al Nileen University, Khartoum, Sudan.,Department of Gastroentrology and Liver Diseases, Gafaar Ibn Oaf Specialized Children Hospital, Khartoum, Sudan
| | - Miskelyemen Elmekki
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| | - Azza Musa
- Department of Statistics and Documentation, Central Laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Nasreldein Abdelhadi
- Faculty of Pharmacy, The National Ribat University, Khartoum, Sudan, Khartoum, Sudan
| | - Abdel Rahim El Hussein
- Department of Microbiology, Central laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan.,Deparment of Virology, Central Laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan
| | - Päivi Saavalainen
- Translational Immunology Research Program, Department of Clinical and Medical Genetics, University of Helsinki, Helsinki, Finland
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Roldán Martín MB, Márquez Romero C, Guerra Vilches E, Ruiz Usabiaga J, Barrio Castellanos R, Martín Frías M, Plaza Oliver D, Camarero Salces C. Celiac disease screening in children and adolescents with type 1 diabetes mellitus: What test should be performed? ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:153-158. [PMID: 34167694 DOI: 10.1016/j.endien.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Children and adolescents with type 1 diabetes mellitus (T1DM) are at high risk for the development of celiac disease (CD) because of the common genetic characteristics of both conditions. The study objectives were to investigate the frequency of the human leukocyte antigen system (HLA) for CD in pediatric T1DM patients and to determine whether HLA testing is suitable for CD screening in that population and is cost-effective as compared to serological screening for CD. PATIENTS AND METHODS A retrospective, descriptive study was conducted in 296 patients (148 girls; 148 boys) with T1DM aged <18 years who attended a Madrid hospital. Data on the frequency of genotypes DQ2/DQ8 in a subgroup of 92 patients and the additional cost of performing HLA typing for screening CD were collected. Only when the risk HLA haplotype (DQ2/DQ8) is negative no further serological screening for CD is required. RESULTS Twenty-three patients with T1DM (7.77%) also had CD. Alleles DQ2 or DQ8 were found in 91.3% of patients in whom the HLA haplotype was studied. Thus, only 8.7% with a negative haplotype would have benefited from HLA testing. The additional cost of HLA typing was € 105.2 for each patient with positive DQ2 or DQ8 in our population. CONCLUSIONS HLA typing is not a cost-effective screening method for CD in T1DM because of the frequent association of T1DM with risk genotypes for CD.
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Affiliation(s)
- M Belén Roldán Martín
- Unidad de Endocrinología y Diabetes, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain.
| | | | | | - Juan Ruiz Usabiaga
- Servicio de Atención al Paciente, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Raquel Barrio Castellanos
- Unidad de Endocrinología y Diabetes, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Martín Frías
- Unidad de Endocrinología y Diabetes, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - David Plaza Oliver
- Servicio de Pediatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Cristina Camarero Salces
- Unidad de Gastroenterología, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
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Roldán Martín MB, Márquez Romero C, Guerra Vilches E, Ruiz Usabiaga J, Barrio Castellanos R, Martín Frías M, Plaza Oliver D, Camarero Salces C. Cribado de enfermedad celiaca en niños y adolescentes con diabetes mellitus tipo 1: ¿qué estrategia utilizar? ENDOCRINOL DIAB NUTR 2021; 68:153-158. [DOI: 10.1016/j.endinu.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Deja G, Sikora D, Pyziak-Skupien A, Klenczar K, Deja R, Jarosz-Chobot P. The Usefulness of Genotyping of Celiac Disease-Specific HLA among Children with Type 1 Diabetes in Various Clinical Situations. J Diabetes Res 2020; 2020:7869350. [PMID: 32149153 PMCID: PMC7057025 DOI: 10.1155/2020/7869350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/31/2019] [Indexed: 01/27/2023] Open
Abstract
AIM The aim of the study was to determine the usefulness of HLA DQ2/DQ8 genotyping in children with T1D in various clinical situations: as a screening test at the diabetes onset, as a verification of the diagnosis in doubtful situations, and as a test estimating the risk of CD in the future. Materials and methods. Three groups of patients with T1D were included: newly diagnosed (n = 92), with CD and villous atrophy (n = 92), with CD and villous atrophy (n = 92), with CD and villous atrophy (n = 30), and with potential CD (n = 23). Genetic tests were performed (commercial test, PCR, and REX), and clinical data were collected. RESULTS The results of genetic tests confirmed the presence of DQ2/DQ8 in 94% of children with diabetes (group I) and in 100% of children with diabetes and CD (groups II and III, respectively). Comparative analysis of the HLA DQ2/DQ8 distribution did not show any differences. Allele DRB1∗04 (linked with HLA DQ8) was significantly less common in children with diabetes and CD (group I versus groups II and III, 56.5% vs. 24.5%; p = 0.001). The probability of developing CD in DRB1∗04-positive patients was 4 times lower (OR 0.25; 95% CI 0.118-0.529; p = 0.001). The probability of developing CD in DRB1∗04-positive patients was 4 times lower (OR 0.25; 95% CI 0.118-0.529; p = 0.001). The probability of developing CD in DRB1∗04-positive patients was 4 times lower (OR 0.25; 95% CI 0.118-0.529. CONCLUSIONS Genotyping HLA DQ2/DQ8 as a negative screening has limited use in assessing the risk of CD at the diabetes onset and does not allow to verify the diagnosis of CD in doubtful situations. The presence of the DRB1∗04 allele modulates the risk of CD and significantly reduces it and can predict a potential form.
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Affiliation(s)
- Grazyna Deja
- Department of Children's Diabetology, Medical University of Silesia in Katowice, Poland
| | - Dominika Sikora
- Students' Scientific Association in Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | | | - Karolina Klenczar
- Department of Children's Diabetology, Medical University of Silesia in Katowice, Poland
| | - Rafał Deja
- Department of Computer Science, WSB University, Dabrowa Gornicza, Poland
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Nagl K, Bollow E, Liptay S, Rosenbauer J, Koletzko S, Pappa A, Näke A, Fröhlich‐Reiterer E, Döring C, Wolf J, Salfeld P, Prinz N. Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac-specific antibody-negativity-A multicenter DPV analysis. Pediatr Diabetes 2019; 20:1100-1109. [PMID: 31430021 PMCID: PMC6899993 DOI: 10.1111/pedi.12908] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/28/2019] [Accepted: 08/13/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To study celiac-specific antibody status over 3 years in patients with type 1 diabetes and biopsy-proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody-negativity (Ab-neg) and staying antibody-positive (Ab-pos). METHODS A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody-status. Differences between Ab-neg (n = 218) and Ab-pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background. RESULTS Thirty-six percent of T1D + CD patients reached and sustained antibody-negativity 3 years after CD diagnosis. The median time until patients returned to Ab-neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab-neg and highest in Ab-pos patients compared to T1D-only patients (adjusted mean (95%CI): 7.72 (7.51-7.92) % vs 8.44 (8.20-8.68) % vs 8.19 (8.17-8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL-cholesterol and frequency of dyslipidemia were significantly lower in Ab-neg compared to T1D-only patients (167 (161-173) mg/dl vs 179 (178-179) mg/dl, P < .001; 90 (84-96) mg/dl vs 99 (98-99) mg/dl, P = .005; 15.7 (10.5-22.9) % vs 25.9 (25.2-26.6) %, P = .017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c (P < .001) and a lower height-SDS (P = .044) was observed in Ab-pos compared to Ab-neg patients. CONCLUSION Only one third of T1D + CD patients reached constant Ab-negativity after CD diagnosis. Achieving Ab-negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.
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Affiliation(s)
- Katrin Nagl
- Department of Pediatrics and Adolescent MedicineMedical University ViennaViennaAustria
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMTUniversity of UlmUlmGermany,German Center for Diabetes Research (DZD)MunichGermany
| | - Susanne Liptay
- Department of Pediatrics and Adolescent Medicine, Kinderklinik SchwabingTechnical University MunichMunichGermany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD)MunichGermany,Institute for Biometrics and Epidemiology, German Diabetes CenterLeibniz Center for Diabetes Research at Heinrich Heine University DuesseldorfDuesseldorfGermany
| | - Sibylle Koletzko
- Ludwig‐Maximilians‐University (LMU) Munich, Division of Pediatric GastroenterologyMunichGermany
| | - Angeliki Pappa
- Department of Pediatrics and Adolescent MedicineUniversity Hospital RWTH AachenAachenGermany
| | - Andrea Näke
- Department of Pediatrics, University Hospital Carl Gustav CarusTechnical University of DresdenDresdenGermany
| | | | | | - Johannes Wolf
- Department of Pediatric and Adolescent MedicineSt. Vincenz Hospital PaderbornPaderbornGermany
| | - Peter Salfeld
- Department of Pediatrics, Center for Diabetes Region Lake of ConstanceCantonal Hospital Thurgau MünsterlingenMünsterlingenSwitzerland
| | - Nicole Prinz
- Institute of Epidemiology and Medical Biometry, ZIBMTUniversity of UlmUlmGermany,German Center for Diabetes Research (DZD)MunichGermany
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