The Prevalence of Celiac Disease-Specific Auto-Antibodies in Type 1 Diabetes in a Moroccan Population

Abstract

Objective. We aimed to determine the prevalence of specific auto-antibodies to celiac disease (CD) in Moroccan type 1 diabetic (T1D) patients and compare the clinical and biological characteristics of seropositive and seronegative cases. Patients and Methods. A cross-sectional study was carried out on 276 T1D patients including 109 adults and 167 pediatric cases. The screening for CD was performed by an Elisa IgA anti-tissue transglutaminase antibody (tTGA) testing, combined with IgA quantification by nephelometry. Positive-IgA-tTGA cases were secondly tested for anti-endomysial antibodies (EMA) using an immunofluorescence technique, and the IgA deficiency cases were screened for IgG-tTGA. Patients with low positive tTGA titers underwent HLA-DQ2/DQ8 typing. Sociodemographic and clinical data of the patients were collected using a hetero-administered questionnaire. The comparison of clinical and biological data between seropositive and seronegative diabetics was done using independent T, Mann–Whitney U, chi-squared, and Fisher tests, which were considered significant if p value <0.05. Results. The prevalence of CD-specific auto-antibodies was estimated to be 9.1% (IC = 95%), with 25 positive cases in tTGA and EMA testing. Eight cases displayed low titers of IgA-tTGA, among which 4 were positive for HLA-DQ2, 1 for HLA-DQ8, and 1 for both DQ2 and DQ8. The other 2 cases had a biopsy-proven CD. Compared to seronegative patients, seropositive cases had a higher percentage of associated autoimmune disorders (16% vs. 2.4%, p=0.008), with a significant lower height Z-scores (median: −0.90 (−3.93 to 0.95) vs. −0.51 (−4.54 to 2.18), p=0.029) and a higher HbA1c level (median: 11.30% (7.31 to 16.00) vs. 9.30% (4.40 to17.31), p=0.022). Conclusion. The current study gave evidence of a high prevalence of CD specific auto-antibodies in T1D population. The co-existence of these two conditions was associated with a poor glycemic control, a lower height, and other autoimmune diseases. These findings may suggest the necessity of a systematic screening of CD in T1D patients.

Celiac disease in children with type 1 diabetes varies around the world: An international, cross‐sectional study of 57 375 patients from the SWEET registry

“…Previous publications mostly include small populations of patients with T1D and CD or include only some regions. 13,14 This study used the international Better control in Pediatric and Adolescent diabeteS: Working to crEate cEnTers of Reference (SWEET) registry, 15 a project designed to optimize outcomes in youth with diabetes worldwide. The SWEET registry collects standardized data from a global network of pediatric diabetes centers, connected through common standards, which allows for evaluation of standardized data sets.…”

Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspects

“…The disease is more prevalent, with large discrepancies between series in the so called high risk groups, such as type 1 diabetes (1–12%); 19 , 20 auto-immune thyroid disease (2–6%); 16 , 21 Down syndrome (2–6%); 22 , 23 auto-immune hepatitis (3–7%); 24 , 25 Turner syndrome (4–5%); 26 , 27 CD first-degree family members (10–20%); 28 , 29 individuals with iron deficiency anemia (3–15%); 29 , 30 patients with osteoporosis (1–3%), 29 and many other clinical conditions. 16 , 28 …”

“…17 It is probably underestimated in South East Asia and Sub-Saharan Africa, and is almost unknown in many other countries. 18 The disease is more prevalent, with large discrepancies between series in the so called high risk groups, such as type 1 diabetes (1-12%); 19,20 autoimmune thyroid disease (2-6%); 16,21 Down syndrome (2-6%); 22,23 auto-immune hepatitis (3-7%); 24,25 Turner syndrome (4-5%); 26,27 CD first-degree family members (10-20%); 28,29 individuals with iron deficiency anemia (3-15%); 29,30 patients with osteoporosis (1-3%), 29 and many other clinical conditions. 16,28 In addition, The incidence of CD has significantly increased over the past 30 years, from 2-3 to approximately 9-13 new cases per 100,000 inhabitants per year.…”

Primary Humoral Immune Deficiencies: Overlooked Mimickers of Chronic Immune-Mediated Gastrointestinal Diseases in Adults

“…CeD prevalence is estimated at around 1% of the worldwide population, thus making it one of the most common autoimmune disorders [ 181 , 182 ]. Besides, the incidence of CeD is higher in first-degree relatives of patients with CeD (Singh et al established CeD prevalence in first-degree relatives at 7.5% and in siblings at 8.9% [ 183 ]), and in patients from risk groups, e.g., with Down syndrome, type 1 diabetes, or IgA deficiency [ 68 , 184 , 185 , 186 ]. Reports indicate that CeD prevalence varies widely among regions and populations, probably due to varying wheat intake and frequency of HLA-DQ2 , HLA-DQ8 , or HLA-DQ2.5 .…”