Background

Patients with T1DM are seen as an at-risk group for coeliac disease. Various and multiple reports suggest that at least 5% (1 in 20) patients with T1DM also develop coeliac disease (CD) in their lifetime. Several guidelines have been published for CD screening and strategies to take over the last few years. ^1-3 Historically, NICE NG20 advised testing for CD at T1DM diagnosis using serology as a screen (NICE NG20) and the subsequent Quality Standard (QS 134) and many parts of the UK do this as routine, perhaps unaware now of the increasing literature around ‘coeliac autoimmunity’.^4,5 In Southeast Scotland, we have screened patients with T1DM since 1995. We have in the last 10+ years deferred serology testing until approximately 4 months after T1DM diagnosis unless testing at diagnosis of T1DM is indicated (due to GI or other symptoms suggestive of CD). Unlike other at-risk conditions, the utility of DQ testing to identify those not at risk is less helpful in T1DM, as only 6% of a cohort within Lothian and Grampian were negative when tested ^6,7.

There is evidence of CD ‘autoimmunity’ in T1DM, and many symptomatic patients may benefit from a watch and wait approach (i.e. defer endoscopy in favour of repeat serology testing and monitoring for symptoms). A significant number of patients who have antibody positivity will not be clinically affected by adopting this approach and it allows families time to understand that development of CD may occur. During this time there is ongoing monitoring of HbA1C, growth and symptoms. Ultimately an upper endoscopy (UGIE) may be required to fully clarify ^8-11. Families are actively involved in the decision making about proceeding to further testing or GFD.