Screening Diabetic Children and Adolescents for Asymptomatic Coeliac Disease: Is It Beneficial? Tripoli University Hospital, Tripoli-Libya

Abstract

Coeliac disease (CD) is common in children and adolescents with type 1 diabetes mellitus; and hence CD screening
of all asymptomatic diabetic children is conducted in many countries. While introduction of a gluten-free diet
(GFD) might improve glycaemic control, the burden of two dietary regimes is a great challenge for the patient, the
caretakers, and healthcare professionals.
The study was aimed to assess the short-term effects of the diagnosis and treatment of asymptomatic CD in children
and adolescents with type 1 diabetes on their diabetic control and body mass index (BMI), one year before and two
years after diagnosing CD and introducing GFD in Tripoli University Hospital, Tripoli, Libya.
Observational longitudinal case-control study of 26 diabetic children with CD and 26 diabetic children without CD
as controls, matched for age, sex, and duration of diabetes.
The age at diagnosis of diabetes mellitus in coeliac group and controls was 6.0 ± 3.98 years and 5.8 ± 3.86 years,
respectively (P = 0.8). The coeliac cases were diagnosed with CD at 10.3 ± 4.27 years of age. HbA1c levels
were 9.76% ± 2.49%, 9.54% ± 2.77%, and 9.62% ± 2.64% in controls, coeliac cases pre-GFD, and post-GFD,
respectively. HbA1c did not change in coeliac cases 1 year before and 2 years after introduction of GFD, but insulin
requirements and BMI SDS increased significantly. HbA1c values during pre-GFD and after-GFD periods were
similar to those of controls with the exception of insulin requirement, which was significantly higher after diagnosis
of CD than in controls (1.01 ± 0.27 unit/kg/day vs. 0.94 ± 0.25 unit/kg/day, P = 0.009), and BMI in control group
was higher than those of both periods in celiac group. Individual analysis of all values at each time point between
cases and controls did not reach statistical significance over the two-year period.
This study suggests that diagnosing CD and introducing GFD in diabetic children have no effect on glycaemic
control. However, it is associated with an increase in daily insulin requirements.