Coeliac disease screening in children with type 1 diabetes mellitus: is it time for a new approach?

Abstract

NICE guidelines recommend annual screening for autoimmune thyroid disease (ATD) in children with type 1 diabetes mellitus (T1DM), but only one initial screen for coeliac disease (CD) at T1DM diagnosis and thereafter if symptomatic. Our study aimed to assess the relationship between the diagnosis of CD and T1DM within our local population, and review the current screening guidelines. We performed a cross-sectional review of patients attending the Oxfordshire Paediatric Diabetes Service to identify those with CD and ATD. Further analysis established how the diagnosis of CD had been made, and the timing of the diagnosis. Of the 342 children within the Oxfordshire Paediatric Diabetes Service, we identified 28 patients with CD (8.2%) and 20 with ATD (5.8%). Only 28% of CD diagnoses were made from initial new diabetic screening bloods, whereas 56% were diagnosed from annual review bloods. One patient (4%) presented with symptoms outside annual review. Forty-four percent of the cohort were diagnosed with CD within the first year of T1DM diagnosis but 12% were diagnosed after five years with T1DM. Our results show a higher prevalence of CD than previous literature has suggested. The majority of cases were asymptomatic and identified by annual review bloods after initially negative screening tests. We recommend that national guidelines should be re-evaluated with on-going yearly screening for CD, at least for the first 10 years following diagnosis of T1DM. Copyright © 2016 John Wiley & Sons.