People with type 1 diabetes are at increased risk for celiac disease (CD), particularly in the early course of diabetes, according to findings from a systematic review of the literature. Most cases of celiac disease were diagnosed within 5 years of type 1 diabetes diagnosis, suggested that screening should be considered at diabetes diagnosis, within 2 and 5 years after diagnosis, and at any time patients show CD-related symptoms, Pharm-Short et al noted in the July issue of Pediatrics.
“Pham-Short et al did a comprehensive systematic review of the literature, and arrived compelling recommendations,” commented Jane Chiang, MD, SVP, Medical Affairs and Community Information, American Diabetes Association (ADA). “The ADA conducts an annual review of the literature, and we will consider their recommendations for the 2016 Standards of Medical Care in Diabetes.”
“The authors recommend more screenings (at diagnosis, 2 and 5 years after diagnosis, and any time symptoms are reported) than those recommended by ADA (soon after diagnosis and if symptomatic) in the 2015 Standards of Medical Care in Diabetes,” Dr. Chiang said.
Nine Cohort Studies Were Analyzed
A total of 9 cohort studies met the inclusion criteria and were included in the analysis. The studies were from Europe (n=7) and Australia (n=2) and included a total of 11,157 patients diagnosed with diabetes at age 21 years or younger.
A total of 587 patients had biopsy-proven CD and the prevalence of this diagnosis from 1.6% to 9.7% among the 9 studies with a weighted pooled prevalence of 5. Patients were asymptomatic at the time of CD diagnosis in 85% of the cases in which data on CD-related symptoms or signs were reported (n=308).
More than half of cases (55%) were diagnosed within 2 years of diabetes diagnosis and 79% within 5 years of diabetes diagnosis. Two studies that included 478 cases showed higher rates of CD in children who were diagnosed with type 1 diabetes before the age of 5 years.
“This is a comprehensive systematic review, with large numbers and long observation period,” Dr. Chiang said. “However, as with all systematic reviews, it is difficult to draw conclusions from the various studies. Given the high numbers (55% and 79%) who were diagnosed [with CD] within 2 and 5 years of diabetes duration, respectively, the authors make a compelling case for CD screening further out from diagnosis. Additionally, the high numbers of subjects (85%) who were asymptomatic also bolster the authors’ recommendation,” Dr. Chiang said.
August 13, 2015
Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig ME. Screening for celiac disease in type 1 diabetes: a systematic review. Pediatrics. 2015;136(1):e170-176.