Background Celiac disease (CD) is an important association with type 1 diabetes (T1DM) with a significant impact on growth and glycemic control. The frequency of coexistence of T1DM and CD is widely described, ranging from 2.5 to 16.4% in 23 studies worldwide, much greater than the general population risk of 1%. The risk of CD is higher among younger children (less than 4 years), females and during the first few years of T1DM diagnosis.

Aim of Study

1. Describe the demographic and clinical characteristics of children with CD with an underlying diagnosis of T1DM

2. Estimate incidence and time trend of CD diagnosis among children with T1DM

3. Evaluate for potential factors that might increase the risk of development of CD among T1DM

Methods A retrospective chart review of EMR of children (age 1–18 years) with T1DM who attended the paediatric endocrine clinic during the period 2010–2021.

Results 898 patients with T1DM were identified during the study period. 93 of them developed CD during the study period, with an incidence of CD among our study cohort of 10.4%. The female gender represents 52.7% of them. The mean age at CD diagnosis was 8 ± 3.5 years, with the average duration of diabetes of 2.9 years ± (2.8) before CD diagnosis. The majority (64.5%) were asymptomatic for CD and were identified through routine screening. Among T1DM with CD majority (83%) developed CD over the first 5 years of T1DM diagnosis. All children with the coexistence of CD and T1DM had positive serology for CD, 79.5% underwent endoscopic duodenal biopsy, and 90.5% of them showed villous atrophy. In our cohort, we were able to identify risk factors for developing celiac disease which includes: Age ≤ 8 years at the time of T1DM diagnosis (P=0.003) and positive family history of CD (P=0.001). The coexistence of autoimmune thyroid disorder (AIDs) and gender were not significant predictors of developing CD in our cohort (P=0.056) and (P=0.92) respectively.

Conclusion(s) The incidence of CD among children with T1DM in our setting is 10.4%; comparable to the regional ' international studies. The estimated cumulative risk of CD is significantly higher in younger children and those with a positive family history of CD. The majority (64%) were asymptomatic for CD and identified through routine screening. More than two third of children with CD were diagnosed during the first 5 years of T1DM diagnosis. These findings support the importance of implementing routine CD screening among children with T1DM to reduce the risk of potential health-related consequences of undiagnosed CD.