Craig Maria E, Prinz Nicole, Boyle Claire T, Campbell Fiona M, Jones Timothy W, Hofer Sabine E, Simmons Jill H, Holman Naomi, Tham Elaine, Fröhlich-Reiterer Elke, DuBose Stephanie, Thornton Helen, King Bruce, Maahs David M, Holl Reinhard W, Warner Justin T
The Children's Hospital at Westmead, Sydney, New South Wales, Australia
University of New South Wales, Sydney, New South Wales, Australia.
Diabetes Care. 2017 Aug;40(8):1034-1040. doi: 10.2337/dc16-2508. Epub 2017 May 25.
Celiac disease (CD) has a recognized association with type 1 diabetes. We examined international differences in CD prevalence and clinical characteristics of youth with coexisting type 1 diabetes and CD versus type 1 diabetes only.
Data sources were as follows: the Prospective Diabetes Follow-up Registry (DPV) (Germany/Austria); the T1D Exchange Clinic Network (T1DX) (U.S.); the National Paediatric Diabetes Audit (NPDA) (U.K. [England/Wales]); and the Australasian Diabetes Data Network (ADDN) (Australia). The analysis included 52,721 youths <18 years of age with a clinic visit between April 2013 and March 2014. Multivariable linear and logistic regression models were constructed to analyze the relationship between outcomes (HbA, height SD score [SDS], overweight/obesity) and type 1 diabetes/CD versus type 1 diabetes, adjusting for sex, age, and diabetes duration.
Biopsy-confirmed CD was present in 1,835 youths (3.5%) and was diagnosed at a median age of 8.1 years (interquartile range 5.3-11.2 years). Diabetes duration at CD diagnosis was <1 year in 37% of youths, >1-2 years in 18% of youths, >3-5 years in 23% of youths, and >5 years in 17% of youths. CD prevalence ranged from 1.9% in the T1DX to 7.7% in the ADDN and was higher in girls than boys (4.3% vs. 2.7%, < 0.001). Children with coexisting CD were younger at diabetes diagnosis compared with those with type 1 diabetes only (5.4 vs. 7.0 years of age, < 0.001) and fewer were nonwhite (15 vs. 18%, < 0.001). Height SDS was lower in those with CD (0.36 vs. 0.48, adjusted < 0.001) and fewer were overweight/obese (34 vs. 37%, adjusted < 0.001), whereas mean HbA values were comparable: 8.3 ± 1.5% (67 ± 17 mmol/mol) versus 8.4 ± 1.6% (68 ± 17 mmol/mol).
CD is a common comorbidity in youth with type 1 diabetes. Differences in CD prevalence may reflect international variation in screening and diagnostic practices, and/or CD risk. Although glycemic control was not different, the lower height SDS supports close monitoring of growth and nutrition in this population.
乳糜泻（CD）与1型糖尿病之间的关联已得到公认。我们研究了共存1型糖尿病和CD的青少年与仅患1型糖尿病的青少年在CD患病率和临床特征方面的国际差异。
数据来源如下：前瞻性糖尿病随访登记处（DPV）（德国/奥地利）；1型糖尿病交换诊所网络（T1DX）（美国）；国家儿科糖尿病审计（NPDA）（英国[英格兰/威尔士]）；以及澳大利亚糖尿病数据网络（ADDN）（澳大利亚）。分析纳入了2013年4月至2014年3月期间就诊的52721名18岁以下青少年。构建多变量线性和逻辑回归模型，以分析结局（糖化血红蛋白、身高标准差评分[SDS]、超重/肥胖）与1型糖尿病/CD和1型糖尿病之间的关系，并对性别、年龄和糖尿病病程进行校正。
经活检确诊的CD患者有1835名青少年（3.5%），诊断时的中位年龄为8.1岁（四分位间距5.3 - 11.2岁）。37%的青少年在CD诊断时糖尿病病程<1年，18%的青少年病程>1 - 2年，23%的青少年病程>3 - 5年，17%的青少年病程>5年。CD患病率从T1DX中的1.9%到ADDN中的7.7%不等，女孩高于男孩（4.3%对2.7%，P<0.001）。与仅患1型糖尿病的儿童相比，共存CD的儿童糖尿病诊断时年龄更小（5.4岁对7.0岁，P<0.001），非白人更少（15%对18%，P<0.001）。CD患者的身高SDS较低（0.36对0.48，校正后P<0.001），超重/肥胖者更少（34%对37%，校正后P<0.001），而平均糖化血红蛋白值相当：8.3±1.5%（67±17 mmol/mol）对8.4±1.6%（68±17 mmol/mol）。
CD是青少年1型糖尿病常见的合并症。CD患病率的差异可能反映了筛查和诊断实践的国际差异，和/或CD风险。尽管血糖控制无差异，但较低的身高SDS支持对该人群的生长和营养进行密切监测。
