Paper
Thursday, 20 July 2006
This presentation is part of : Evidence-Based Practice for Children with Diabetes
Celiac Autoimmunity in Children with New Onset Type 1 Diabetes : Evidence for Screening at Diagnosis
Marianne Buzby, MSN, CPNP1, Christina Preis, MSN, CRNP1, and Kathryn Murphy, RN, PhD2. (1) Division of Endocrinology/Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (2) Department of Endocrinology, Childerns Hospital of Philadelphia, Philadelphia, PA, USA
  Background: Strong evidence suggests increased occurrence of celiac disease in children with type 1 diabetes (T1D).  Of children with T1D, 3.3% have been reported to have a positive celiac screen at diagnosis.   Manifestations are highly variable including gastrointestinal symptoms; growth failure, delayed puberty, hypoglycemia; and aymptomatic presentations.
 
Aims: The purpose of this study is to describe the incidence of a positive celiac screen in our population of children with new onset T1D, to identify characteristics of the children with positive screens, and to identify a population that will be followed prospectively to determine the natural history of this disorder.
 
Methods: In January 2005, we implemented a best practice screening all children admitted to our children’s hospital with new onset type1 diabetes for celiac disease.  Laboratory data for all patients admitted between 1/1/05 – 9/30/05 for new onset diabetes were reviewed.
 
Results: 135 patients were diagnosed with new onset T1D during the study period.  18/135 did not have a celiac screen.  Of the remaining 117 patients, 97 (M = 54; 1-18 years, mean = 9.0) had celiac screening within normal limits.  1 specimen was described as “too lipemic” to be interpreted.  19/117 (16.2 %) had an abnormal screen.  Of the abnormal screens, 9 patients had low IgA making the results inconclusive.  The remaining 10 patients (M = 5; 4-16 years, mean = 9.6) had a positive celiac screen.
 
Conclusions:In our population of children with new onset T1D, 8.5% had a clearly positive celiac screen.  Ongoing data collection is necessary to more accurately assess the incidence of positive antibodies for celiac disease in children newly diagnosed T1D.  Prospective data collection will determine how many children with a positive screen have biopsy proven celiac disease. 
 

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