Prevalence of positive coeliac serology in a cohort of South African children with type 1 diabetes mellitus

Abstract

Background. Coeliac disease (CD) is characterised by immune-mediated damage to the mucosa of the small intestine. Both CD and type 1 diabetes (T1D) have common auto-immune origins. Many patients with CD and T1D are asymptomatic or present with only mild symptoms; hence early diagnosis may only be facilitated by serological screening. Distal duodenal biopsy remains the gold standard for confirming the diagnosis.
Objective. To describe the prevalence of CD in T1D patients presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central hospital (IALCH) in Durban and document the relationship between positive coeliac serology and small-bowel biopsy results.
Methods. A retrospective chart review was done at IALCH, the paediatric tertiary referral centre for KwaZulu-Natal (KZN) Province. The study sample included all patients with newly diagnosed T1D diagnosed between January 2008 and December 2011.
Results. A total of 120 newly diagnosed T1D patients were included in the study, of whom 49 (40.8%) were coeliac serology positive and 61 (50.8%) serology negative. There was no significant difference between the two groups regarding mean age of presentation with diabetes, race, sex, urban v. rural origin and baseline anthropometric measurements. Of patients in the serology-positive group, 97.6% had no symptoms suggestive of CD. Of the 49 patients who were coeliac serology positive, 8 (16%) were biopsied: 3 (37.5%) were positive, 1 (12.5%) had intra-epithelial lymphocytes and 4 (50%) were negative. There was a strong positive correlation between biopsy results and titres of endomysial antibody results (p=0.047).
Conclusion. There is a high prevalence of coeliac serology positivity in newly diagnosed T1D patients in KZN. This study provides evidence for screening of children with T1D for CD, and also confirms the low prevalence of symptoms.