Abstract:
Background: Type 1 Diabetes Mellitus (T1DM) is prevalent amongst children in the UK, with 3,883 diagnosed between 2021–2022, exposing them to an increased risk of Coeliac Disease (CD). Missed diagnosis of CD can cause negative sequelae including malnutrition, growth defects and osteoporosis. NICE guidance states that at T1DM diagnosis (here defined as within three months of) all patients should be offered serological testing of CD. This screening comprises total IgA and IgA tTG, in accordance with ESPGHAN guidance.
Methods: Patients newly diagnosed with T1DM between January 2020 and December 2022, whilst under aged 18, were identified from Birmingham Children’s Hospital’s database. Retrospective review of the 144 electronic records allowed analysis of the presence and type of CD screening and the date it was conducted. If CD screen was positive, further evaluation determined whether the correct referral had been completed.
Results: Total IgA levels were not measured in any patient, therefore correct CD screening was not conducted. 136 patients received IgA tTG testing, 11 of which breached the 90-day diagnostic window. 8 patients received neither total IgA or IgA tTG testing. 10 patients had positive or equivocal coeliac serology. 4 of these patients received appropriate gastroenterology referral for further testing.
Discussion: Birmingham Children’s Hospital partially adheres to ESPGHAN guidelines regarding CD screening in newly diagnosed T1DM. Failure to measure total IgA risks false seronegativity and possible missed CD diagnosis since low total IgA, as occurs in IgA deficiency associated with CD, can mask a high IgA tTG titre. Delayed diagnosis or referral may postpone treatment, increase disease burden and prevent specialist management. Interventions should ensure correct CD screening is requested by clinicians within an appropriate timeframe.
