Checking Your Child for Celiac

A new study shows that almost 10% of children diagnosed with type 1 diabetes before age four will also develop celiac disease, usually within ten years of their diagnosis of diabetes.

In a person with celiac disease, eating certain foods (mainly wheat) causes a reaction in the intestine. When this happens again and again, the lining of the intestine is damaged. Nutrients aren't absorbed well. Growth is affected, and bones may be brittle.

Since 1995, the Italian Society of Pediatric Endocrinology and Diabetes has recommended yearly screening for celiac disease in children and teens with type 1 diabetes. Screening is done with a blood test. If certain antibodies are present, a biopsy of the small intestine is done to confirm the diagnosis of celiac disease.

Researchers analyzed data from 4,322 children and teens with type 1 diabetes. Thirty-four were diagnosed with celiac disease before they were diagnosed with type 1, and 258 were diagnosed with celiac after or at the same time as they were diagnosed with type 1. Girls had a higher risk of celiac than boys: 9.2% of girls versus 4.8% of boys had celiac. When grouped by age, 9.7% of those diagnosed with type 1 before age 4 had celiac, while only 5% of those diagnosed with type 1 after age nine also had celiac disease. The researchers also found that celiac disease is rarely found after ten years' duration of diabetes.

In those patients who were diagnosed with diabetes first and then celiac, 14.5% had symptoms. Most had gastrointestinal symptoms, a few had atypical symptoms of short stature and/or anemia.

What You Can Do
Be alert for signs and symptoms of celiac disease. In children, these include:

• Diarrhea
• Stools that are foul-smelling, bulky, and that float
• Failure to grow
• Muscle wasting
• Anemia
• Pale skin
• Unexplained hypoglycemia
• Rickets

1. Using a blood test, screen children with type 1 diabetes for celiac disease, even those who have no symptoms.
2. Do the screening within four years of the diagnosis of diabetes. If finances allow, consider screening every year at least until the child has had diabetes for ten years.
3. Pay particular attention to the higher risk groups: girls, and children diagnosed with diabetes before age four.