Celiac Disease in Syrian Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Abstract

Abstract Introduction  Celiac disease (CD) is highly prevalent in patients with type 1 diabetes mellitus (T1DM). However, the rate of CD in Syrian children and adolescents with T1DM is unknown. We aimed to investigate the prevalence and characteristics of CD in our unprivileged rural community. Methods  Children and adolescents with T1DM who were regularly followed in a private endocrine clinic in Raqqa City, Syria, were evaluated from October 2018 to November 2021. Screening for CD was performed using either anti-tissue transglutaminase antibodies, antideaminated gliadin antibodies, or endomysial antibodies. Patients with positive results were referred for duodenal biopsy using Marsh classification whenever possible. The prevalence of CD was calculated for both seropositive and biopsy-proven cases. Results  Ninety-four patients with T1DM, 51 (54.3%) females, were included. The mean age was 11.6 years, and mean hemoglobin A1c (HbA1C) was 9.2%. All patients were screened for CD. Fourteen patients (14.9%) were positive, and seven (7.4%) performed a duodenal biopsy that proved positive for CD in all cases. CD seropositivity was more common in female than male patients (21.6 vs. 7%, respectively, p -value <0.05). Patients with seropositivity for CD had lower hemoglobin levels compared to seronegative patients, with a mean difference of 0.87 (95% confidence interval: 0.2–1.5; p -value <0.05). There was a statistically significant correlation between hypothyroidism and celiac seropositivity ( p -value <0.05). There were no differences in age, weight, height, HbA1C, puberty status, or duration of diabetes between patients with and without CD. No correlation was identified between the incidence of hypoglycemia or diabetic ketoacidosis and the presence of CD. Conclusion  In our community, we revealed a high prevalence of CD in Syrian children and adolescents with T1DM. Our results are alarming and point to the need for establishing a national CD registry to prompt physicians for proper screening and early management in high-risk populations.