Brady Ryan P, Jensen Elizabeth T, Rigdon Joseph, Crimmins Nancy A, Mallon Daniel, Dolan Lawrence M, Imperatore Giuseppina, Kahkoska Anna R, Mottl Amy K, Honor Ann, Pettitt David J, Merjaneh Lina, Dabelea Dana, Shah Amy S
Department of Pediatrics, Cincinnati Children's Hospital & University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Pediatr Diabetes. 2023;2023. doi: 10.1155/2023/9038795. Epub 2023 May 29.
Celiac disease (CD) in adults with type 1 diabetes has been associated with increased cardiovascular risk and the earlier occurrence of diabetes-associated complications. In the Search for Diabetes in Youth study, we aimed to assess the frequency of CD and the potential for undiagnosed CD among youth with childhood onset type 1 diabetes. In addition, we assessed the burden of cardiovascular risk factors and diabetes-associated complications in youth with type 1 diabetes by CD status and IgA tissue transglutaminase autoantibody (tTGA) levels.
2,444 youths with type 1 diabetes completed a CD questionnaire and underwent tTGA testing. Integrating the celiac disease questionnaire and tTGA results for this cross-sectional analysis, participants were categorized as follows: (1) reported CD; (2) seropositive for CD (no reported CD and seropositive tTGA); and (3) type 1 diabetes only (comparison group: no reported CD and seronegative tTGA). Subanalyses were performed on those with no reported CD and tTGA ≥10x ULN, designated potentially undiagnosed CD. Cardiovascular risk factors and diabetes-associated complications were evaluated by CD status and tTGA levels utilizing a Poisson model to estimate relative risk.
Reported CD in youths with type 1 diabetes was 7%. Seropositivity for tTGA with no reported CD was present in 4%, and 1.2% had potentially undiagnosed CD. Youths with potentially undiagnosed CD had a 2.69x higher risk of diabetic retinopathy than comparison group. In addition, CD with tTGA <0.05 (controlled CD) was associated with lower HbA1c.
Undiagnosed CD is likely present in youths with type 1 diabetes and potentially undiagnosed CD is associated with a higher risk of diabetic retinopathy. These findings indicate the importance of routine screening for CD in type 1 diabetes in youths.
1型糖尿病成年患者的乳糜泻（CD）与心血管风险增加及糖尿病相关并发症的较早发生有关。在青少年糖尿病研究中，我们旨在评估儿童期发病的1型糖尿病青少年中CD的发生率以及未诊断出CD的可能性。此外，我们根据CD状态和IgA组织转谷氨酰胺酶自身抗体（tTGA）水平评估了1型糖尿病青少年中心血管危险因素和糖尿病相关并发症的负担。
2444名1型糖尿病青少年完成了CD问卷并接受了tTGA检测。将乳糜泻问卷和tTGA结果整合用于本次横断面分析，参与者被分类如下：（1）报告患有CD；（2）CD血清学阳性（未报告CD且tTGA血清学阳性）；（3）仅患有1型糖尿病（对照组：未报告CD且tTGA血清学阴性）。对未报告CD且tTGA≥10倍正常上限（ULN）的患者进行亚分析，这些患者被指定为可能未诊断出的CD。利用泊松模型估计相对风险，根据CD状态和tTGA水平评估心血管危险因素和糖尿病相关并发症。
1型糖尿病青少年中报告患有CD的比例为7%。未报告CD但tTGA血清学阳性的比例为4%，1.2%的患者可能未诊断出CD。可能未诊断出CD的青少年患糖尿病视网膜病变的风险比对照组高2.69倍。此外，tTGA<0.05的CD（受控CD）与较低的糖化血红蛋白（HbA1c）相关。
1型糖尿病青少年中可能存在未诊断出的CD，且可能未诊断出的CD与糖尿病视网膜病变的较高风险相关。这些发现表明在青少年1型糖尿病中常规筛查CD的重要性。
