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It has been known for 30 years or more that there is an association between type 1 diabetes and coeliac disease. About 5% of children and adolescents with type 1 diabetes have coeliac disease, which may be asymptomatic or atypical. A study at a London paediatric diabetes clinic (C Goh and K Banerjee. Postgraduate Medical Journal 2007;83:132–6) has provided more data about the prevalence and clinical features of coeliac disease in these children.
The study population consisted of 58 males and 55 females, all under the age of 19 years (mean 12.1 years, range 6.5–17.2 years) and with type 1 diabetes. Seven patients (6.2%) had positive tests for coeliac antibodies (antiendomysial and tissue transglutaminase or antigliadin antibodies, or both) and five of these seven (4.4% of the 113 patients) had coeliac disease confirmed by jejunal biopsy (one had a negative biopsy and one has not yet had a biopsy). The time between the diagnosis of diabetes and the diagnosis of coeliac disease varied widely. Of the five patients with confirmed coeliac disease, one had no symptoms, four had recurrent abdominal pain, two had weight loss and two had recurrent hypoglycaemia. Coeliac disease did not affect growth or diabetic control. The effect of a gluten‐free diet on the diabetes could not be assessed adequately. Two of the seven patients with coeliac antibodies had autoimmune thyroid disease, one with hypothyroidism and one with hyperthyroidism. Non‐adherence to a gluten‐free diet may be common among patients with diabetes and coeliac disease and the avoidance of gluten‐containing sources of carbohydrate may be difficult. Nevertheless, untreated coeliac disease carries a risk of loss of bone density and of gastrointestinal malignancy and the authors of this paper recommend periodic screening of children with type 1 diabetes for coeliac disease.