Prevalence of celiac disease in patients with type 1 diabetes: a systematic review and meta-analysis

Abstract

Background. Celiac disease (CD) is more prevalent among type 1 diabetes (T1D) patients compared to the general population and can be accompanied by hypoglycemia episodes in T1D patients. Studies worldwide have reported CD prevalence with large variability. This study aimed to estimate the pooled prevalence of CD in T1D patients. Methods. PubMed, Web of Science, Science Direct, and Scopus were searched without time limitation using the keywords: Celiac Disease, Gluten Enteropathy, Gluten- Sensitive Enteropathy, Wheat Hypersensitivity, Tissue Transglutaminase Antibody, Endomysial Antibody Disease, Diabetes Mellitus, and IDDM. Random-effects inverse variance-weighted model, subgroup analysis, and meta-regression were implemented. Heterogeneity was examined using Cochran’s Q test and I2 statistics. Results. A pooled analysis of 55 articles with total sample size 71,853 revealed that the CD prevalence in patients with T1D was 5.08% (95% CI: 4.44%, 5.73%) with large heterogeneity (I2 = 84%). To account for publication bias, using trim-and-fill method, the pooled prevalence was 4.0% (95% CI: 3.38%, 4.73%). The prevalence of CD was higher in Asia (6.53%, 95% CI: 4.89%, 8.16%) compared to USA (4.89%, 95% CI: 3.85%, 5.93%) and Europe (4.76%, 95% CI: 3.78%, 5.74%). In addition, studies conducted after 2008 reported pooled prevalence (6.37%, 95% CI: 5.25%, 7.49%) significantly higher than those conducted before 2008 (4.14%, 95% CI: 3.19%, 5.09%). Studies with quality score 10 had significantly higher prevalence (7.0%, 95% CI: 5.04%, 8.96%) compared with quality score 7 (3.66%, 95% CI: 2.61%, 4.70%). Conclusion. CD is highly prevalent in T1D patients. Studies from Asia, those published after the year 2008, and studies with quality score 10 had higher pooled CD prevalence. Therefore, early screening for CD in T1D patients is important to prevent complications of CD.