Glucometabolic Control and Anti-Transglutaminase Antibodies at Celiac Disease Onset in Type 1 Diabetes Youth - Report - MDSpire

Glucometabolic Control and Anti-Transglutaminase Antibodies at Celiac Disease Onset in Type 1 Diabetes Youth

  • By

  • Francesca Di Candia

  • Francesco Maria Rosanio

  • Roberto Franceschi

  • Alessandro Fierro

  • Riccardo Bonfanti

  • Francesca Cardella

  • Valentino Cherubini

  • Giuseppe D’Annunzio

  • Barbara Felappi

  • Dario Iafusco

  • Brunella Iovane

  • Claudio Maffeis

  • Giulio Maltoni

  • Francesca Olivieri

  • Gabriele Olivieri

  • Barbara Piccini

  • Elvira Piccinno

  • Barbara Predieri

  • Ivana Rabbone

  • Maria Rossella Ricciardi

  • Giuseppina Salzano

  • Riccardo Schiaffini

  • Gianluca Tornese

  • Angela Zanfardino

  • Marco Marigliano

  • Riccardo Troncone

  • Riccardo Pertile

  • Luigi Greco

  • Renata Auricchio

  • Enza Mozzillo

  • ISPED Diabetes Study Group Collaborators

  • Francesco Gallo

  • Caterina Grosso

  • Carlo Ripoli

  • Fiorella De Berardinis

  • Susanna Coccoli

  • Valentina Tiberi

  • Sonia Toni

  • Maurizio Delvecchio

  • Rosanna Roppolo

  • Fortunato Lombardo

  • Stefano Passanisi

  • Bruno Bombaci

  • Alberto Casertano

  • Nicola Minuto

  • Marta Bassi

  • Evelina Maines

  • Silvia Savastio

  • Elena Inzaghi

  • Andrea Rigamonti

  • Giulio Frontino

  • Patrizia Bruzzi

  • Claudia Piona

  • November 4, 2025

  • 0 min

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Glucometabolic Control and Anti-TTG Antibodies at Celiac Disease Onset in Youth with Type 1 Diabetes

Overview

In children and adolescents with type 1 diabetes (T1D) and celiac disease (CD), higher anti-transglutaminase IgA antibody (anti-TTG IgA) titers correlate with worse glycemic control (HbA1c) and more severe intestinal mucosal damage (Marsh grade) at CD diagnosis. An anti-TTG IgA cutoff of 11 times the upper limit of normal (ULN) may be optimal to avoid biopsy in this population. Additionally, autoimmune comorbidities are more prevalent in T1D-CD individuals, especially when CD precedes T1D.

Background

Celiac disease is more prevalent in children and adolescents with type 1 diabetes compared to the general population. Anti-TTG IgA antibodies are used to screen for CD and correlate with mucosal damage severity. Current guidelines recommend regular screening for CD in youths with T1D, but biopsy-free diagnosis criteria established for the general pediatric population may require adjustment in T1D patients. The relationship between anti-TTG IgA levels, glycemic control, and intestinal damage at CD diagnosis in T1D patients has not been fully elucidated.

Data Highlights

ParameterFinding
Correlation between HbA1c at CD diagnosis and fold-anti-TTG IgASpearman r = 0.14, P = .0047
Optimal anti-TTG IgA cutoff for sparing biopsy11 times ULN
Prevalence of autoimmune comorbidities in T1D-CD vs T1D-onlySignificantly higher in T1D-CD (χ2 25.4, P < .001)
Subgroup with CD before T1D (CD_FIRST)Highest prevalence of autoimmune comorbidities (P < .001)

Key Findings

  • HbA1c at CD diagnosis positively correlates with anti-TTG IgA titers in youths with T1D.
  • Higher anti-TTG IgA titers associate with more severe intestinal mucosal damage (higher Marsh grade).
  • An anti-TTG IgA cutoff of 11 times ULN is suggested for biopsy avoidance in T1D-CD patients, slightly higher than in the general pediatric population.
  • Individuals with both T1D and CD exhibit a higher prevalence of additional autoimmune diseases compared to T1D-only peers.
  • The subgroup with CD onset before T1D (CD_FIRST) shows the greatest burden of autoimmune comorbidities.

Clinical Implications

Clinicians should consider that worse glycemic control at CD diagnosis may reflect higher anti-TTG IgA titers and more severe intestinal damage in youths with T1D. The anti-TTG IgA threshold for biopsy-free CD diagnosis may need adjustment to 11 times ULN in this population. Given the high prevalence of autoimmune comorbidities, especially when CD precedes T1D, routine screening for T1D in children diagnosed with CD is advisable.

Conclusion

In pediatric patients with T1D and CD, glucometabolic control correlates with serological and histological markers of CD severity. Adjusted diagnostic thresholds and vigilant autoimmune screening are warranted to optimize management in this dual-autoimmunity population.

References

  1. Italian Society of Paediatric Endocrinology and Diabetology (ISPED) CELDIA10-19 Study
  2. European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guidelines 2020
  3. International Society for Pediatric and Adolescent Diabetes (ISPAD) Recommendations

Original Source(s)

Glucometabolic Control and Anti-Transglutaminase Antibodies at Celiac Disease Onset in Type 1 Diabetes Youth

  • by Francesca Di Candia, Francesco Maria Rosanio, Roberto Franceschi, Alessandro Fierro, Riccardo Bonfanti, Francesca Cardella, Valentino Cherubini, Giuseppe D’Annunzio, Barbara Felappi, Dario Iafusco, Brunella Iovane, Claudio Maffeis, Giulio Maltoni, Francesca Olivieri, Gabriele Olivieri, Barbara Piccini, Elvira Piccinno, Barbara Predieri, Ivana Rabbone, Maria Rossella Ricciardi, Giuseppina Salzano, Riccardo Schiaffini, Gianluca Tornese, Angela Zanfardino, Marco Marigliano, Riccardo Troncone, Riccardo Pertile, Luigi Greco, Renata Auricchio, Enza Mozzillo, ISPED Diabetes Study Group Collaborators, Francesco Gallo, Caterina Grosso, Carlo Ripoli, Fiorella De Berardinis, Susanna Coccoli, Valentina Tiberi, Sonia Toni, Maurizio Delvecchio, Rosanna Roppolo, Fortunato Lombardo, Stefano Passanisi, Bruno Bombaci, Alberto Casertano, Nicola Minuto, Marta Bassi, Evelina Maines, Silvia Savastio, Elena Inzaghi, Andrea Rigamonti, Giulio Frontino, Patrizia Bruzzi, Claudia Piona

  • November 4, 2025

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