TY - JOUR
T1 - Glucometabolic Control and Anti-Transglutaminase Antibodies at Celiac Disease Onset in Type 1 Diabetes Youth
AU - ISPED Diabetes Study Group Collaborators
AU - Di Candia, Francesca
AU - Rosanio, Francesco Maria
AU - Franceschi, Roberto
AU - Fierro, Alessandro
AU - Bonfanti, Riccardo
AU - Cardella, Francesca
AU - Cherubini, Valentino
AU - D’Annunzio, Giuseppe
AU - Felappi, Barbara
AU - Iafusco, Dario
AU - Iovane, Brunella
AU - Maffeis, Claudio
AU - Maltoni, Giulio
AU - Olivieri, Francesca
AU - Olivieri, Gabriele
AU - Piccini, Barbara
AU - Piccinno, Elvira
AU - Predieri, Barbara
AU - Rabbone, Ivana
AU - Ricciardi, Maria Rossella
AU - Salzano, Giuseppina
AU - Schiaffini, Riccardo
AU - Tornese, Gianluca
AU - Zanfardino, Angela
AU - Marigliano, Marco
AU - Troncone, Riccardo
AU - Pertile, Riccardo
AU - Greco, Luigi
AU - Auricchio, Renata
AU - Mozzillo, Enza
AU - Gallo, Francesco
AU - Grosso, Caterina
AU - Ripoli, Carlo
AU - De Berardinis, Fiorella
AU - Coccoli, Susanna
AU - Tiberi, Valentina
AU - Toni, Sonia
AU - Delvecchio, Maurizio
AU - Roppolo, Rosanna
AU - Lombardo, Fortunato
AU - Passanisi, Stefano
AU - Bombaci, Bruno
AU - Casertano, Alberto
AU - Minuto, Nicola
AU - Bassi, Marta
AU - Maines, Evelina
AU - Savastio, Silvia
AU - Inzaghi, Elena
AU - Rigamonti, Andrea
AU - Frontino, Giulio
N1 - Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. See the journal About page for additional terms.
PY - 2026/5
Y1 - 2026/5
N2 - Context: Anti-transglutaminase antibodies (anti-TTG IgA) titer is associated with mucosal damage in celiac disease (CD). Objective: The primary focus was to correlate anti-TTG IgA titer, HbA1c when CD occurs (HbA1cCD), and Marsh grade in children and adolescents with type 1 diabetes (T1D) at the time of CD diagnosis. As secondary outcomes, we assessed the optimal anti-TTG IgA upper limit of normal (ULN) cutoff for sparing biopsy, and personal and familial autoimmunity history in the individuals with T1D and CD (T1D-CD) compared with T1D-only. Methods: In this retrospective observational study, among 6933 individuals with T1D onset (2010-2019), 556 were grouped according to CD onset: before (CD_FIRST), concomitant (CD_CONCOMITANT), or after T1D (T1D_FIRST), and compared with 141 T1D without CD. Measures included HbA1cCD, fold-anti-TTG IgA, anti-TTG IgA cutoff, and autoimmunity history of both groups, as well as Marsh grade in T1D-CD. Results: In youths with T1D, HbA1cCD was associated with increased fold-anti-TTG IgA (Spearman r = 0.14, P = .0047). The optimal anti-TTG IgA cutoff for sparing biopsy was 11 ULN. Autoimmunity was prevalent in T1D-CD individuals, who showed more comorbidities than controls (χ2 25.4, P < .001), particularly the CD_FIRST (P < .001). Conclusion: In children with T1D-CD, worse glucometabolic control is associated with an increase in fold anti-TTG IgA and with worse Marsh grade. A slightly higher anti-TTG IgA cutoff may be necessary for sparing biopsy compared to children in the general population. Higher prevalence of autoimmune comorbidities in CD_FIRST suggests that screening for T1D in the CD population should be mandatory.
AB - Context: Anti-transglutaminase antibodies (anti-TTG IgA) titer is associated with mucosal damage in celiac disease (CD). Objective: The primary focus was to correlate anti-TTG IgA titer, HbA1c when CD occurs (HbA1cCD), and Marsh grade in children and adolescents with type 1 diabetes (T1D) at the time of CD diagnosis. As secondary outcomes, we assessed the optimal anti-TTG IgA upper limit of normal (ULN) cutoff for sparing biopsy, and personal and familial autoimmunity history in the individuals with T1D and CD (T1D-CD) compared with T1D-only. Methods: In this retrospective observational study, among 6933 individuals with T1D onset (2010-2019), 556 were grouped according to CD onset: before (CD_FIRST), concomitant (CD_CONCOMITANT), or after T1D (T1D_FIRST), and compared with 141 T1D without CD. Measures included HbA1cCD, fold-anti-TTG IgA, anti-TTG IgA cutoff, and autoimmunity history of both groups, as well as Marsh grade in T1D-CD. Results: In youths with T1D, HbA1cCD was associated with increased fold-anti-TTG IgA (Spearman r = 0.14, P = .0047). The optimal anti-TTG IgA cutoff for sparing biopsy was 11 ULN. Autoimmunity was prevalent in T1D-CD individuals, who showed more comorbidities than controls (χ2 25.4, P < .001), particularly the CD_FIRST (P < .001). Conclusion: In children with T1D-CD, worse glucometabolic control is associated with an increase in fold anti-TTG IgA and with worse Marsh grade. A slightly higher anti-TTG IgA cutoff may be necessary for sparing biopsy compared to children in the general population. Higher prevalence of autoimmune comorbidities in CD_FIRST suggests that screening for T1D in the CD population should be mandatory.
KW - anti-tissue transglutaminase
KW - autoimmunity
KW - celiac disease
KW - gluten-free diet
KW - glycosylated hemoglobin
KW - type 1 diabetes
UR - https://www.scopus.com/pages/publications/105036547397
U2 - 10.1210/clinem/dgaf604
DO - 10.1210/clinem/dgaf604
M3 - Article
SN - 0021-972X
VL - 111
SP - 1389
EP - 1396
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 5
ER -
SDG 3 Good Health and Well-being