Article Synopsis
- Type 1 diabetes (T1D) and celiac disease (CD) have a worldwide prevalence ranging from 1.6% to 16.4%, but current screening guidelines lack a solid evidence base.
- A systematic review was performed, analyzing longitudinal cohort studies that screened T1D patients for CD, involving over 11,000 children and adolescents.
- The findings revealed a 5.1% prevalence of biopsy-proven CD among T1D patients, with most cases being diagnosed within 5 years of T1D onset, warranting consideration of CD screening at diagnosis and again within 2 to 5 years.
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Article Abstract
Background And Objectives: Prevalence rates of type 1 diabetes (T1D) and celiac disease (CD) vary from 1.6% to 16.4% worldwide. Screening guidelines are variable and not evidence based. Our aim was to conduct a systematic review of CD in T1D.
Methods: Medline, Embase, and the Cochrane Library were searched. Studies were limited to those in English and in humans. We selected longitudinal cohort studies screening for CD in T1D with at least 5 years of follow-up. Screening rates, characteristics, and prevalence of biopsy-proven CD in people with T1D were extracted.
Results: We identified 457 nonduplicate citations; 48 were selected for full-text review. Nine longitudinal cohort studies in 11,157 children and adolescents with 587 cases of biopsy-proven CD met the inclusion criteria. Median follow-up was 10 years (range: 5-18 years). The weighted pooled prevalence of CD was 5.1% (95% confidence interval: 3.1-7.4%). After excluding 41 cases with CD onset before T1D, CD was diagnosed in 218 of 546 (40%) subjects within 1 year, in 55% within 2 years, and in 79% within 5 years of diabetes duration. Two studies (478 cases) reported higher rates of CD in children aged <5 years at T1D diagnosis. The duration of follow-up varied across the included studies. CD screening frequency progressively decreased with increased T1D duration.
Conclusions: Because most cases of CD are diagnosed within 5 years of T1D diagnosis, screening should be considered at T1D diagnosis and within 2 and 5 years thereafter. CD screening should be considered at other times in patients with symptoms suggestive of CD. More research is required to determine the screening frequency beyond 5 years of diabetes duration.
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| http://dx.doi.org/10.1542/peds.2014-2883 | DOI Listing |
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