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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2023; 06(02): 059-063
DOI: 10.1055/s-0043-1768462
Original Article

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

Ibrahim Alali 
1   Internal Medicine Department, Faculty of Medicine, Damascus University, Damascus, Syria
2   Endocrinologist, Raqqa, Syria
,
Bachar Afandi 
3   The Endocrine Division, Tawam Hospital, Al Ain, United Arab Emirates
4   Department of Medicine, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
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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.

Keywords

celiac disease - type 1 diabetes mellitus - adolescents - children - Syria

Authors' Contributions

I.A. has full access to all the data presented and takes responsibility for the integrity and accuracy of the content. All patient's data are available upon request as SPSS sheet. Both authors contributed to the conception and writing of the manuscript, literature search, revision, and approval of the final version. I.A. runs a private clinic of endocrinology in Raqqa governorate besides his affiliation with Damascus University; patient's data were collected during his work in Raqqa.


Compliance with Ethical Principles

The study was based on routinely collected data as part of standard care. All parents granted verbal permission to use the collected data.


Financial Support and Sponsorship

None.




Publication History

Article published online:
29 May 2023

© 2023. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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