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Screening Detected Celiac Disease in Children with Type 1 Diabetes Mellitus: Effect on the Clinical Course (A Case Control Study)

Rami, Birgit*; Sumnik, Zdenek†; Schober, Edith*; Waldhör, Thomas‡; Battelino, Tadej§; Bratanic, Nina§; Kürti, Kalman¶; Lebl, Jan#; Limbert, Catarina∥; Madacsy, Laszlo**; Odink, Roetloef J. H††; Paskova, Magdalena‡‡; Soltesz, Gyula§§

Journal of Pediatric Gastroenterology & Nutrition: September 2005 - Volume 41 - Issue 3 - pp 317-321
Original Articles: Gastroenterology

Objective: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study.

Methods: Cases: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent biopsy. Controls: two controls in the same center were chosen, (stratified by age and age-at-diabetes onset) who were negative for endomysial antibodies (n = 195). Height, weight, HbA1c, insulin dosage and acute complications were documented for at least 1 year of follow up.

Results: Mean age of diabetes manifestation was 6.5 ± 4.1 years and diagnosis of celiac disease was made at 10.0 ± 5.4 years. Biopsy showed total or subtotal mucosal atrophy in 74 patients. The mean observation period after the diagnosis of celiac disease was 3.3 ± 1.9 years. Mean HbA1c levels were similar between cases and controls (8.63% ± 1.45% versus 8.50% ± 1.39%; P = 0.35). There was also no difference in the frequency of severe hypoglycemia, ketoacidosis and the applied insulin dosage (P = 0.45). Body mass index-standard deviation score at celiac disease diagnosis (0.57 ± 1.24 versus 0.52 ± 1.07) and height-standard deviation score (0.14 ± 1.13 versus 0.30 ± 0.95) did not differ between cases and controls. After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared with their controls (P < 0.05). Female cases also had a lower body mass index than female controls (P = 0.067).

Conclusion: In a cohort of diabetic children, silent celiac disease had no obvious effect on metabolic control but negatively influenced weight gain.

Departments of *Pediatrics and ‡Epidemiology, Medical University Vienna, Vienna, Austria; †Second Department of Pediatrics, Medical University, Prague, Czech Republic; §Pediatric Endocrinology/Diabetology Department, University Children's Hospital, Ljubljana, Slovenia; ¶Children's Hospital, Szeged, Hungary; #Department of Pediatrics, Charles University, Prague, Czech Republic; ∥Pediatric Endocrinology & Diabetes, University Children's Hospital, Dona Estefania, Lisbon, Portugal; **Department of Pediatrics, Semmelweis University, Budapest, Hungary; ††Beatrix Children's Hospital, Groningen, Netherlands; ‡‡Children's Hospital, Kosice, Slovakia; and §§Department of Pediatrics, University Medical School, Pecs, Hungary

Received August 11, 2004; accepted May 11, 2005.

Address correspondence and reprint requests to E. Schober University Children's Hospital Waehringerguertel 18-20 A 1090 Vienna, Austria. (e-mail: edith.schober@meduniwien.ac.at).

© 2005 Lippincott Williams & Wilkins, Inc.