engleski

SPONTANEOUS DISAPPEARANCE OF TISSUE TRANSGLUTAMINASE ANTIBODIES IS COMMON IN CHILDREN DIAGNOSED WITH DIABETES MELLITUS TYPE 1

Objectives and Study: The prevalence of celiac disease (CD) among type 1 diabetes mellitus (T1DM) patients is 5– 10 times higher than in the general population. Thus, evaluating celiac serology is indicated at diagnosis of T1DM and on follow up. The aim of our study was to investigate the prevalence of spontaneous disappearance of tissue transglutaminase antibodies (TTG) in patients diagnosed with T1DM. Methods: We performed a retrospective analysis of 815 children diagnosed with T1DM in our institution during a 6 years period and identified patients with elevated serum TTG. Patients were analyzed in 2 groups: Group 1 consisted of patients diagnosed with CD and Group 2: patients with spontaneous disappearance of TTG on a gluten containing diet. Group 1 was further divided to Group 1a–patients adherent to GFD and Group 1b those not adherent. Comparison between the groups was done at first positive TTG finding and one year later, for hemoglobin A1C (HbA1C) and anthropometric measurements. Results: After excluding 77 patients due to incomplete data, we identified 48/738 (6.5%) patients with elevated TTG blood levels. Of these, CD was diagnosed in 31 (Group 1). TTG antibodies disappeared on gluten containing diet in 17/48 (35.4%) children (Group 2, median follow up time: 4.1 years, range 1.7–5.7 years). In Group 1, TTG blood levels were significantly higher than in Group 2 (P¼0.001) and in all cases in Group 2, TTG levels were < X 3 the upper limit of normal (ULN). A year after diagnosis, there was no significant difference between Group 1a, Group 1b and Group 2 neither in the HbA1c levels (7.1% vs. 8.2% vs. 7.37%, P¼0.24), nor in the anthropometric measurements (median Z score difference for weight 0.26 vs. 0.09 vs. 0.01, P¼0.91 ; median z score difference for height 0.02 vs. 0 vs. 0.33, P¼0.47 ; and z score difference for BMI 0.2 vs. 0.2 vs. 0.39, P¼0.47). Conclusion: TTG spontaneously disappear in one-third of children diagnosed with T1DM. We suggest that physicians treating T1DM patients should consider 12 months serologic follow-up on gluten-containing diet rather than immediate duodenal biopsy at least in children with mildly elevated TTG.

celiac disease

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