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High rate of spontaneous normalization of celiac serology in a cohort of 446 children with type 1 diabetes: a prospective study.
- Source :
-
Diabetes care [Diabetes Care] 2015 May; Vol. 38 (5), pp. 760-6. Date of Electronic Publication: 2015 Mar 17. - Publication Year :
- 2015
-
Abstract
- Objective: In children with type 1 diabetes mellitus (T1DM), elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize, despite continued consumption of gluten. We aimed to investigate the prevalence of spontaneous normalization of anti-tTG levels and the existence of factors predictive for this outcome.<br />Research Design and Methods: All children referred from 2002 to 2012 were screened for celiac disease (CD) at diabetes onset and at specific intervals. In the presence of a high anti-tTG titer or clinical symptoms, children were offered endoscopy, and asymptomatic patients with a low anti-tTG titer were invited to a second serological test after 6 months of eating a gluten-containing diet.<br />Results: The study included 446 children. Of these, 65 (14.5%) became positive for celiac serology: 38 (58%) had a persistently elevated anti-tTG titer and 27 (41%) fluctuating anti-tTG titer; 18 (28%) became negative. The prevalence of positive CD autoimmunity and overt CD was 14.3% (95% CI 11-17) and 8.5% (95% CI 5-10), 15- and 8-times higher than the general pediatric population, respectively. Asymptomatic children older than 9.1 years at T1DM onset had the lowest risk to develop CD.<br />Conclusions: Serum anti-tTG levels decreased spontaneously in 40% of children with T1DM and became negative in 20%, despite gluten consumption. This finding supports the hypothesis of a state of temporary positivity of celiac serology in children with diabetes. In absence of clinical symptoms or signs of CD, histological confirmation of the disease and the gluten-free diet should be postponed to avoid unnecessary procedures and reduce an additional psychological burden.<br /> (© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)
- Subjects :
- Analysis of Variance
Child
Child, Preschool
Diet, Gluten-Free
Female
Glutens administration & dosage
Glutens immunology
Humans
Immunoglobulin A metabolism
Male
Prospective Studies
Protein Glutamine gamma Glutamyltransferase 2
Risk Factors
Autoantibodies metabolism
Autoimmunity immunology
Celiac Disease immunology
Diabetes Mellitus, Type 1 immunology
GTP-Binding Proteins metabolism
Transglutaminases metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1935-5548
- Volume :
- 38
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Diabetes care
- Publication Type :
- Academic Journal
- Accession number :
- 25784659
- Full Text :
- https://doi.org/10.2337/dc14-2890