From: Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas
Organization | Indications for Screening/Investigation | Screening Test | Frequency | Treatment | |
---|---|---|---|---|---|
 |  |  |  | Symptomatic | Asymptomatic |
International Society for Pediatric and Adolescent Diabetes [55] (Consensus Based) | (i) Diarrhea, flatulence(ii) Unexplained poor growth(iii) Abdominal pain(iv) Dyspeptic symptoms(v) Anemia(vi) Recurrent aphthous ulceration | (i) IgA levels (ii) EMA and TTG IgA | (i) At time of T1D diagnosis and every second year thereafter(ii) If clinical situation suggests possible CD, or if the child has first-degree relative with CD, more frequent assessment is indicated | Gluten-free diet | Gluten-free diet may be considered justified with goal of reducing risk of complications. |
Canadian Diabetes Association [57] (Evidence Grade D: Consensus) | (i) Symptoms of classic or atypical CD (ii) Poor linear growth(iii) Fatigue(iv) Recurrent GI symptoms(v) Poor weight gain (vi) Anemia, (vii) Unexplained frequent hypoglycemia/poor metabolic control | (i) TTG (ii) IgA levels | (i) Based on clinical symptoms | Gluten-free diet | Parents should be told treatment of asymptomatic CD with gluten-free diet in T1D is controversial. |
American Diabetes Association [58] (Evidence Grade E: Consensus) | (i) Failure to gain weight(ii) Gastroenterologic symptoms(iii) Growth failure(iv) Weight loss(v) Recent T1D diagnosis | (i) TTG or EMA(ii) IgA levels | (i) Periodic re-screening of asymptomatic individuals or if indications for screening develop | Gluten-free diet | All children with confirmed diagnosis of CD should be put on a gluten-free diet. |
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition [56] (Consensus Based) | (i) Non-GI symptoms of CD (osteoporosis, short stature, dermatitis herpetiformis, delayed puberty, iron-deficient anemia) (ii) Other (autoimmune thyroiditis, T1D, Williams syndrome, Down syndrome, Turner syndrome) | (i) TTG IgA | (i) Asymptomatic individuals who belong to high risk groups with negative serological tests should be considered for repeat testing at intervals | Gluten-free diet | Gluten-free diet recommended for asymptomatic children with an associated condition such as T1D. |