Elsevier

Diabetes & Metabolism

Volume 33, Issue 6, December 2007, Pages 453-458
Diabetes & Metabolism

Original article
Prevalence and clinical features of celiac disease in 950 children with type 1 diabetes in FrancePrévalence et présentation clinique en France de la maladie cœliaque chez 950 enfants atteints de diabète de type 1

https://doi.org/10.1016/j.diabet.2007.06.004Get rights and content

Abstract

The prevalence of celiac disease is higher in children with type 1 diabetes mellitus (DM) than in the general pediatric population, but may vary widely across countries. Sensitive and specific antibody tests are available for detecting celiac disease.

Aims

To evaluate the prevalence in France of histologically documented celiac disease in a vast cohort of children with type 1 DM, and to describe the features of celiac disease and treatment response.

Methods

Retrospective cohort study of 950 children with type 1 diabetes seen between 1994 and 2001. Antibodies to gliadin, reticulin, endomysium and transglutaminase were looked for one to seven times in each patient.

Results

Fifteen patients (1.6%) had biopsy-confirmed celiac disease. Symptoms led to the diagnosis in six patients (mean age, 7 years) and screening tests in nine patients (mean age, 11 years). Anti-endomysium antibodies were consistently positive. Tests for HLA-DQB1 0201 and/or 0302 were positive. Anti-endomysium antibody seroconversion was seen in two patients, 2 and 6 years, respectively, after the diagnosis of diabetes. In another patient, the biopsy became abnormal 6 years after the first positive anti-endomysium antibody test (latent form). After a mean of 3 years on a gluten-free diet, significant increases were noted in body weight (P = 0.04) and insulin dose (P = 0.05); clinical symptoms completely resolved in five of the six symptomatic patients.

Conclusions

The prevalence of celiac disease is higher in children with type 1 DM than in the general pediatric population. Serological screening is useful for diagnosing asymptomatic celiac disease, detecting seroconversion and monitoring latent forms of disease.

Résumé

Buts

Évaluer la prévalence en France de la MC prouvée histologiquement dans une large cohorte d'enfants DT1; décrire les caractéristiques au diagnostic de MC et l'évolution sous régime sans gluten.

Méthode

Étude rétrospective d'une cohorte de 950 enfants DT1 suivis depuis l'introduction du dépistage (1994–2001). Recherche des anticorps antigliadine, antiréticuline, anti-endomysium au moins une fois (1 à 7). Biopsie du grêle dans tous les cas avec anticorps positifs.

Résultats

Quinze cas de MC ont été prouvés par biopsie du grêle, soit une prévalence de 1,6 %. Six enfants ont été diagnostiqués sur des symptômes de MC (âge = 7 ans) et neuf enfants ont été dépistés par la recherche systématique des anticorps de MC (âge = 11 ans), les anticorps anti-endomysium sont positifs dans tous les cas. Chez deux enfants, une séroconversion a été observée deux ans et six ans après le diagnostic de DT1. Une forme latente a été diagnostiquée par un suivi de six ans (positivité des anticorps anti-endomysium avec biopsie normale devenant pathologique trois ans après). Après trois ans en moyenne de régime sans gluten, le poids rapporté à l'âge et au sexe (P = 0,04) et la dose d'insuline en U/kg par jour (P = 0,05) ont augmenté significativement, et les signes cliniques ont disparu chez cinq sur les six patients symptomatiques.

Conclusion

La prévalence de la MC en France est plus élevée chez l'enfant DT1 (1,6 %) que dans la population générale (0,04 %). Le dépistage au diagnostic de DT1 et au cours du suivi permet de diagnostiquer et traiter des formes asymptomatiques, de dépister des séroconversions et de surveiller les formes latentes.

Section snippets

Patients and methods

We retrospectively studied a vast cohort of children with type 1 DM. Charts of all patients (n = 950) receiving follow-up for type 1 DM at the pediatric diabetology Department of the Robert Debre University Hospital in Paris, France, between January 1, 1994, and December 31, 2001, were studied. We excluded patients with all other forms of diabetes. Routine screening for celiac disease antibodies in type 1 DM was introduced in 1994 in our department and performed in the same laboratory throughout

Prevalence

Of the 950 children with type 1 DM in the study cohort, 15 (ten girls and five boys) had histologically documented celiac disease, yielding a prevalence of 1.6%. Villous atrophy was total in nine of them and subtotal in six.

Of the 15 cases of celiac disease, 14 were diagnosed after the introduction of routine screening for specific antibodies. In one case, the diagnosis of celiac disease was made, before 1994, upon evaluation of symptoms.

Characteristics of the 15 patients at diagnosis of celiac disease

Mean age (± SD) at diagnosis of type 1 DM was 6 ± 4.2 years

Seroconversion

This was documented in two patients (cases #1 and #3). Antibodies specific for celiac disease was initially negative, but became positive during follow-up. One of these patients (case #1) was a girl of Portuguese descent with an unremarkable family history. Type 1 DM was diagnosed when she was 13 months old and, at the time, all screening tests for celiac disease were negative. One year later, low titers of antigliadin antibodies were found (IgA AGA, 22 IU; IgG AGA, 23 IU). At 3 years of age,

Discussion

We evaluated the prevalence of celiac disease on the basis of histology rather than positive antibody markers in a cohort of 950 children followed-up for type 1 DM. This is the largest type 1 DM paediatric population studied in France. The prevalence of celiac disease was 1.6%, 40 times higher than its prevalence in the general French pediatric population (0.41/1000) [13]. However, only symptomatic forms are included in prevalence studies among the general population. In fact, the prevalence of

Acknowledgments

We thank all the pediatric dietitians and gastroenterologists (Professor J.P. Cezard and Professor J.P. Hugot) who managed the children followed-up at the Robert Debré Hospital; Professor Peuchmaur and Professor Sterkers for the histopathology and immunogenetic tests; and the Association des Juniors en Pédiatrie and Gallia for helping to edit the manuscript.

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