Prevalence and Clinical Profile of Celiac Disease in Children with Type 1 Diabetes Mellitus in Al Jabal Al Akhdar

Abstract

To estimate the prevalence of celiac disease (CD) in children with type 1 diabetes mellitus (T1DM) and to evaluate the epidemiological and clinical profiles of CD in screened patients during follow-up. This observational study enrolled 250 children with T1DM attending the pediatric endocrinology clinic at Al-Bayda Medical Center Teaching Hospital between May 2020 and May 2022. Patients were screened for CD by evaluating immunoglobulin A (IgA) and immunoglobulin G (IgG) anti-tissue transglutaminase (anti-tTG) antibodies. A total of 250 patients (104 boys [41.6%] and 146 girls [58.4%]) with a mean age of 9.46 ± 3.28 years were included. Anti-tTG antibodies were positive in 27 patients, indicating a seroprevalence of 10.8%. Among the seropositive cases, 55.6% (15/27) were girls and 44.4% (12/27) were boys. Intestinal biopsy was performed on 7 of these patients, all of whom exhibited histological changes consistent with CD; the remaining seropositive patients declined the biopsy. Classical presentations of the disease were lacking in the majority of patients. The most frequent clinical presentation in patients with co-occurring CD and T1DM was anemia (37.0%), followed by chronic diarrhea (11.1%) and short stature (11.1%). The occurrence of anemia and chronic diarrhea was significantly higher in patients with CD compared to those with T1DM alone (p < 0.001 and p = 0.029, respectively). Celiac disease is prevalent among children with T1DM (10.8% seroprevalence) and often presents atypically, with anemia being the most common symptom rather than classical gastrointestinal features. Routine autoantibody screening is highly recommended for the early diagnosis and effective management of CD in patients with T1DM.