Higher Rates of Celiac Disease Serology and Biopsy Positivity in Adults with Type 1 Diabetes
Authors: MAHMUD FARID H. , CLARKE ANTOINE B. , JOACHIM KARIYM C. , ASSOR ESTHER , PARIKH AMISH , ADVANI ANDREW , PERKINS BRUCE A. , SHAH BAIJU R. , ZUIJDWIJK CAROLINE S. , MCDONALD CHARLOTTE , MACK DAVID , KOLTIN DROR , HSIEH EUGENE , SZENTGYORGYI EVA M. , SAIBIL FRED , MUKERJI GEETHA , LOCHNAN HEATHER A. , GILBERT JEREMY , BAX KEVIN , LAWSON MARGARET L. , BEATON MELANIE D. , SALOOJEE NAV A. , LOU OLIVIA , GALLEGO PATRICIA H. , HOULDEN ROBYN L. , ARONSON RONNIE , KIRSCH SUSAN E. , PATERSON WILLIAM G. , PUNTHAKEE ZUBIN , MARCON MARGARET A. 
Published: June 2018

Background: Celiac Disease (CD) is more common in individuals with type 1 diabetes (T1D) and is frequently asymptomatic. Despite this association, evidence as to the impact and diagnostic accuracy of CD screening is limited in asymptomatic patients with T1D.
Objective: To describe CD serology and biopsy positivity rates in T1D patients screened as part of the Celiac Disease and Diabetes Dietary Intervention and Evaluation Trial (CD-DIET).
Methods: Prospective data from patients, aged 8-45 years, with T1D screened at 22 sites across Ontario, Canada as part of CD-DIET were analyzed with respect to demographics, clinical symptoms and CD status. Serological and biopsy-confirmed rates of CD were evaluated.
Results: Overall, 2585 patients were approached and 2386 patients completed serological testing using tissue transglutaminase antibodies. The sample included 1298 (54.4%) adults, aged 19-45 years, and 1088 (45.6%) pediatric subjects, aged 8-18 years. Mean age was 23.1 ± 10.3 years, 49.2% female, with mean duration of diabetes 12.2 ± 9.0 years. A small number of screened patients (N=45) were symptomatic for CD as per study criteria with clinical GI symptoms (n=39), osteoporosis (n=2), apthous ulcers (n=1), weight loss (n=1), and/or anemia (n=2). Overall, 140 asymptomatic patients were serologically positive for CD. A positive CD serology rate of 7.2% (94/1298) was seen in adults as compared to 4.2% (46/1088) in pediatric subjects (p=0.0064). Endoscopy was completed in 104 patients and CD was subsequently confirmed using duodenal biopsy in 54/71 adults (76.1%) and 28/33 pediatric patients (84.8%), with overall biopsy positivity rates of 4.2% and 2.6% respectively (p=0.034).
Conclusions: Significant differences were observed in CD serology and biopsy positivity, with higher rates seen in adults as compared with children with T1D, which may be due to increasing risk of autoimmune co-morbidities with age as well as many adults being naïve to celiac disease screening.

Disclosure
F.H. Mahmud: None. A.B. Clarke: None. K.C. Joachim: None. E. Assor: None. A. Parikh: None. A. Advani: Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. Other Relationship; Self; Boehringer Ingelheim GmbH. B.A. Perkins: Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH, Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Abbott. Speaker's Bureau; Self; Abbott, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation, Dexcom, Inc.. B.R. Shah: None. C.S. Zuijdwijk: None. C. McDonald: None. D. Mack: None. D. Koltin: None. E. Hsieh: None. E.M. Szentgyorgyi: None. F. Saibil: None. G. Mukerji: None. H.A. Lochnan: Research Support; Self; Amylin Pharmaceuticals, Boston Therapeutics, Inc., Sanofi. J. Gilbert: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi. K. Bax: None. M.L. Lawson: None. M.D. Beaton: Advisory Panel; Self; Takeda Canada Inc., Janssen Pharmaceuticals, Inc., AbbVie Inc.. N.A. Saloojee: None. O. Lou: None. P.H. Gallego: None. R.L. Houlden: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., AstraZeneca, Eli Lilly and Company. R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck & Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc.. S.E. Kirsch: None. W.G. Paterson: None. Z. Punthakee: Research Support; Self; Amgen, Astra Zeneca/Bristol Myers Squibb, Lexicon, Merck, NovoNordisk, Sanofi. Speaker's Bureau; Self; Abbott, Astra Zeneca/Bristol Myers Squibb, Boehringer Ingelheim/Eli Lilly, Janssen, Merck, NovoNordisk, Pfizer, Sanofi. Advisory Panel; Self; Astra Zeneca/Bristol Myers Squibb, Boehringer Ingelheim/Eli Lilly, Dexcom, Janssen, Medtronic, NovoNordisk, Pfizer, Sanofi. M.A. Marcon: None.