Endocrine Abstracts

Objectives: Recently updated NICE guidelines (2015) on coeliac screening for children with Type 1 diabetes mellitus (T1DM) recommend just one initial screen for coeliac disease (CD) at the time of T1DM diagnosis and thereafter only if symptomatic. This is in contrast to the recommendation for on-going annual screening for autoimmune thyroid disease (ATD). Our unit has historically performed annual screening for both ATD and CD. Our study aimed to establish whether current NICE recommendations for CD screening were sufficient, or if indeed they could result in missed diagnoses.

Methods: We performed a cross-sectional review of patients attending our Paediatric Diabetes Service to identify those with CD and ATD. Further analysis established how the diagnosis of CD had been made, the timing of the diagnosis compared to onset of and duration of T1DM, and presence or absence of symptoms. We performed an extensive review of national and international screening guidelines, comparing these against the new NICE guidelines.

Results: Of the 342 children within our Paediatric Diabetes Service, we identified 28 patients with CD (8.2%) and 20 with ATD (5.8%). Only 28% of CD diagnoses were made from initial new diabetic screening bloods whereas 56% were diagnosed from annual review bloods. One patient (4%) presented with symptoms outside of annual review (no data in 12%). 44% of the cohort were diagnosed with CD within the first year of T1DM diagnosis but 12% were diagnosed after 5 years with T1DM.

Several alternative guidelines recognised the increased incidence of CD in the first 5 years after diagnosis of T1DM, and therefore advocate more screening within the initial 5 years.

Conclusions: Previous literature suggests that CD is significantly less prevalent than ATD in T1DM. UK studies suggest a prevalence of 4.4–5.8% of CD in children with T1DM. Our results show a higher prevalence of CD than this previous literature has suggested. The majority of cases were asymptomatic and identified by annual review bloods after initial negative screening tests. We recommend that national guidelines should be re-evaluated with on-going yearly screening for CD, at least for the first 5–10 years following diagnosis of T1DM.