Celiac screening for kids with type 1 diabetes
Several studies to date have found that people with type 1 diabetes (T1D) tend to have celiac disease more often than individuals in the general population. But a new study says screening for the disease may miss a significant portion of asymptomatic T1D cases.
Michael Haller, MD, a pediatric endocrinologist at UF Health, told Medscape Medical News in a recent interview that screening every type 1 diabetes patient for the disease presents a unique clinical challenge.
Physicians are often confused about whether or not to screen in their own practices “because the frequency of finding folks with [T1D] positive antibodies who are unaffected by the disease is pretty high, and a lot of those families choose not to go forward with biopsies or follow a gluten-free diet. It makes it challenging for a treating physician to know the best thing to do for the patient if you’re not going to do anything about the information.”
About 3.5 to 10 percent of individuals with celiac disease develop type 1 diabetes and visa versa. That’s between approximately 49,000- 140,000 children each year. Research has also shown that T1D is usually diagnosed prior to celiac disease, and that the onset age of T1D is typically younger in those with both diseases. Yet, the prevalence of CD can be difficult to determine because it often comes without symptoms.
“It’s a problem with all screening programs. You have to decide where the level is to make the cutoff. I think at the end of the day it has to be the physician and the patient who decide how relevant that diagnosis might be for them,” says Dr. Haller.
He added, “You can make an argument either way. There’s a high likelihood we’re missing patients who have clinically relevant celiac disease out there because we don’t screen enough. On the other hand, if you screen everybody you’re going to spend a lot of money screening and not pick up patients with clinically relevant disease.”
Future research studies will focus on understanding the effects of celiac disease on growth, body weight, and bone minerilaztion in screened populations of T1D in order to make the case for screening T1D patients who show no symptoms.