Glucometabolic Control and Anti-Transglutaminase Antibodies at Celiac Disease Onset in Type 1 Diabetes Youth.
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Di Candia Francesca, Rosanio Francesco Maria, Franceschi Roberto, Fierro Alessandro, Bonfanti Riccardo, Cardella Francesca, Cherubini Valentino, D'Annunzio Giuseppe, Felappi Barbara, Iafusco Dario, Iovane Brunella, Maffeis Claudio, Maltoni Giulio, Olivieri Francesca, Olivieri Gabriele, Piccini Barbara, Piccinno Elvira, Predieri Barbara, Rabbone Ivana, Ricciardi Maria Rossella, Salzano Giuseppina, Schiaffini Riccardo, Tornese Gianluca, Zanfardino Angela, Marigliano Marco, Troncone Riccardo, Pertile Riccardo, Greco Luigi, Auricchio Renata, Mozzillo Enza, ISPED Diabetes Study Group Collaborators
Аннотация
OBJECTIVE: The primary focus was to correlate anti-TTG IgA titer, HbA1c when CD occurs (HbA1cCD), and Marsh grade in children and adolescents with type 1 diabetes (T1D) at the time of CD diagnosis. As secondary outcomes, we assessed the optimal anti-TTG IgA upper limit of normal (ULN) cutoff for sparing biopsy, and personal and familial autoimmunity history in the individuals with T1D and CD (T1D-CD) compared with T1D-only.
METHODS: In this retrospective observational study, among 6933 individuals with T1D onset (2010-2019), 556 were grouped according to CD onset: before (CD_FIRST), concomitant (CD_CONCOMITANT), or after T1D (T1D_FIRST), and compared with 141 T1D without CD. Measures included HbA1cCD, fold-anti-TTG IgA, anti-TTG IgA cutoff, and autoimmunity history of both groups, as well as Marsh grade in T1D-CD.
RESULTS: In youths with T1D, HbA1cCD was associated with increased fold-anti-TTG IgA (Spearman r = 0.14, P = .0047). The optimal anti-TTG IgA cutoff for sparing biopsy was 11 ULN. Autoimmunity was prevalent in T1D-CD individuals, who showed more comorbidities than controls (χ2 25.4, P < .001), particularly the CD_FIRST (P < .001).
CONCLUSION: In children with T1D-CD, worse glucometabolic control is associated with an increase in fold anti-TTG IgA and with worse Marsh grade. A slightly higher anti-TTG IgA cutoff may be necessary for sparing biopsy compared to children in the general population. Higher prevalence of autoimmune comorbidities in CD_FIRST suggests that screening for T1D in the CD population should be mandatory.