Celiac disease and type I (insulin-dependent) diabetes mellitus in childhood: follow-up study

J Diabetes Complications. May-Jun 1996;10(3):154-9. doi: 10.1016/1056-8727(96)00056-6.

Abstract

To ascertain the specificity of IgA and IgG antigliadin (IgA-AGA, IgG-AGA), IgA-antireticulin (R1-ARA), and antiendomysial (AEA) antibodies for the diagnosis of celiac disease, we evaluated 133 type I diabetic children aged 1.4-28.4 years (mean 14.1 +/- 6.6), with diabetes from onset to 20.5 years. Fifty-three patients were considered at onset and 49 of these also during follow-up. IgA-AGA and IgG-AGA were determined by enzyme-linked immunosorbent assay (ELISA), R1-ARA and AEA by indirect immunofluorescence. IgA-AGA were positive in 20 of 133 (15%), IgG-AGA were positive in seven of 133 (5.26%), while R1-ARA and AEA were positive in three patients. At the onset of disease we found elevated IgA-AGA in 17 of 53 (32%) patients, IgG-AGA in four (7.55%) patients, three of them with IgA-AGA as well; R1-ARA and AEA were present in three (5.66%) patients, all with high IgA-AGA levels. During 1-10 year follow-up IgA-AGA decreased to within the normal range in 13 patients, with elevated IgA-AGA at onset but without R1-ARA and AEA; in four patients with high IgA-AGA at onset, IgA-AGA remained constantly elevated as did R1-ARA and AEA in three of them; and two patients, without IgA-AGA, R1-ARA, and AEA at onset, became positive for all three antibodies. Intestinal biopsy confirmed a diagnosis of celiac disease in five of these with IgA-AGA, R1-ARA, and AEA, but not in one patient with persistent IgA-AGA but no AEA and R1-ARA, suggesting that R1-ARA and AEA are more reliable markers for the screening of celiac disease in type I diabetic patients.

MeSH terms

  • Adolescent
  • Adult
  • Autoantibodies / blood*
  • Body Height
  • Celiac Disease / complications*
  • Celiac Disease / epidemiology
  • Celiac Disease / immunology
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / immunology
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Follow-Up Studies
  • Gliadin / immunology
  • HLA-DR Antigens / blood
  • Humans
  • Immunoglobulin A / blood
  • Immunoglobulin G / blood
  • Infant
  • Longitudinal Studies
  • Male
  • Muscle Fibers, Skeletal / immunology
  • Reticulin / immunology
  • Risk Factors
  • Sex Characteristics
  • Time Factors

Substances

  • Autoantibodies
  • HLA-DR Antigens
  • Immunoglobulin A
  • Immunoglobulin G
  • Reticulin
  • Gliadin