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Table 2 Clinical Recommendations for Screening and Treatment of CD in T1D.

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.