Antibody Negativity, Growth, and Metabolic Control in T1D With Celiac Disease

Diagnosis of Celiac disease. Health history document with diagnosis celiac disease is on doctors table, surrounded by stethoscope, blood test and ultrasound results and digital thermometer
Researchers found approximately one-third of patients with type 1 diabetes and celiac disease were able to achieve sustained celiac-specific antibody negativity after celiac disease diagnosis.

Approximately one-third of patients with type 1 diabetes (T1D) and celiac disease (CD) were able to achieve sustained celiac-specific antibody negativity after CD diagnosis, which was associated with better growth and metabolic control, according to study results published in Pediatric Diabetes.

Given that many patients with CD have no symptoms of the disease, guidelines from the International Society for Pediatric and Adolescent Diabetes recommend regular screening for CD at T1D onset and every 1 to 2 years thereafter. The goal of this study was to explore the celiac-specific antibody status in patients with T1D after CD diagnosis and determine any clinical differences between patients with both diseases and those with T1D alone.

The researchers used a diabetes data acquisition system to analyze data on pediatric patients with T1D from 368 participating centers in Germany, Austria, Luxemburg, and Switzerland.

The study cohort included 608 patients with T1D and CD, of whom 68% had ≥1 negative antibody test within the first 3 years after CD diagnosis. Differences between patients who reached constant antibody negativity (n=218; median age, 11.2 years) and patients who remained antibody positive (n=158; median age, 13.2 years) after duodenal biopsy were assessed and compared with data from 26,833 patients with T1D only (median age, 16.9 years). The median duration to achieve continuous antibody negativity was 0.86 years.

At the time of CD diagnosis, glycated hemoglobin (HbA1c) values were not different between patients who reached consistent antibody negativity and patients who were antibody positive. However, 3 years after CD diagnosis, mean HbA1c was significantly higher in patients who remained antibody positive (8.44%; 95% CI, 8.20%-8.68%) compared with patients who achieved consistent antibody negativity (7.72%; 95% CI, 7.51%-7.92%; P <.001). Mean HbA1c values did not differ significantly between patients who remained antibody positive and those with T1D only (8.19%; 95% CI, 8.17%-8.21%).

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Analysis of longitudinal trends for patients with CD were assessed from 1 year prior to 6 years after CD diagnosis. While HbA1c values remained relatively stable in patients who maintained antibody negativity, there was a constant increase in HbA1c in patients who were antibody positive in the years after CD diagnosis. In addition, significantly lower height standard deviation scores were observed in patients who achieved antibody negativity compared with those who were antibody positive (who remained constantly smaller).

Height and weight standard deviation scores were significantly lower in patients with T1D and CD — whether they achieved antibody negativity or not — compared with the T1D-only group. Furthermore, compared with the T1D-only group, lipid profile was significantly better 3 years after diagnosis in patients with T1D and CD who achieved antibody negativity, with lower total cholesterol (167 mg/dL vs 179 mg/dL; P <.001) and low-density lipoprotein cholesterol levels (90 mg/dL vs 99 mg/dL; P =.005).

The study had several limitations, including the multicenter design and missing information regarding antibody titers, compliance to a gluten-free diet, or counseling provided to the patients and families.

“[T]his is the first study to examine the longitudinal course of CD-antibodies after CD diagnosis…in a large cohort of [patients with T1D] with CD seroconversion to [antibody negativity] as proxy for good dietary adherence,” concluded the researchers. “As the restrictions of [a gluten-free diet] can be an additional burden for patients with T1D, we need to identify those patients who struggle early and provide additional support.”

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Nagl K, Bollow E, Liptay S, et al. Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac-specific antibody-negativity — a multicenter DPV analysis [published online August 20, 2019]. Pediatr Diabetes. doi:10.1111/pedi.12908