Occurrence of celiac disease after onset of type 1 diabetes: a 6-year prospective longitudinal study

Pediatrics. 2002 May;109(5):833-8. doi: 10.1542/peds.109.5.833.


Objective: To investigate the prevalence of celiac disease in a large cohort of children and adolescents at the onset of type 1 diabetes and the occurrence of new cases during a 6-year follow-up.

Methods: We prospectively studied, by repeated serologic screening, 274 consecutive patients at the onset of type 1 diabetes (age [mean +/- standard deviation]: 8.28 +/- 4.65 years) for 6 subsequent years. One patient had a diagnosis of celiac disease before the onset of diabetes. The immunoglobulin A-antiendomysium antibody test was selected as the screening test; patients with positive results (++ or +++) or with 2 consecutive weak positive tests (+) were considered appropriate for the jejunal biopsy.

Results: At diabetes onset, 15 (5.5%) of 273 patients tested positive with the antiendomysium test; jejunal biopsy was performed in 10, and celiac disease was diagnosed in 9. The prevalence of biopsy-confirmed celiac disease at the manifestation of diabetes was 3.6% (10 of 274 patients). Twelve more patients with a negative antiendomysium antibody test at diabetes onset tested positive during the follow-up within 4 years; 10 of them had biopsies performed, and 7 had celiac disease. Therefore, the overall prevalence of biopsy-confirmed celiac disease in the entire cohort of patients was 6.2%. The age at diabetes onset in patients with and without celiac disease was not different (7.88 +/- 5.69 vs 8.3 +/- 4.58 years). The majority of cases of celiac disease were asymptomatic in their presentation, and no signs of overt malnutrition were documented.

Conclusions: The prevalence of celiac disease in patients with type 1 diabetes is approximately 20 times higher than in the general population. Sixty percent of cases are already present at diabetes onset, mostly undetected, but an additional 40% of patients develop celiac disease a few years after diabetes onset. Extending screening programs for celiac disease after the onset of type 1 diabetes is recommended, even in the absence of clinical symptoms.

MeSH terms

  • Adolescent
  • Autoantibodies / analysis
  • Autoantibodies / immunology
  • Biomarkers / analysis
  • Body Height
  • Body Mass Index
  • Celiac Disease / diagnosis
  • Celiac Disease / epidemiology*
  • Celiac Disease / immunology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Comorbidity
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / immunology
  • Female
  • Humans
  • Immunoglobulin A / analysis
  • Immunoglobulin A / immunology
  • Immunoglobulin G / analysis
  • Immunoglobulin G / immunology
  • Infant
  • Italy / epidemiology
  • Longitudinal Studies
  • Male
  • Prevalence
  • Prospective Studies
  • Serologic Tests


  • Autoantibodies
  • Biomarkers
  • Immunoglobulin A
  • Immunoglobulin G