Antibodies are predictive for diagnosis of celiac disease in pediatric type 1 diabetes
IgA anti-transglutaminase 2 (TGA-IgA)-antibody-levels are used to screen for celiac disease in children and adolescents with type 1 diabetes (T1D). However, TGA-IGA-levels can fluctuate in T1D and there is no antibody-threshold for performing biopsies to confirm a diagnosis of celiac disease. Our two-center retrospective study in 588 youths with T1D aimed to define an optimal TGA-IgA cut-off for performing diagnostic biopsies for confirmation and to assess whether tracking TGA-IgA evolution or adding other antibodies can improve biopsy indications.
A TGA-IgA cut-off of approximately 6.1× the upper limit of normal best predicted biopsy-confirmed celiac disease, and combining TGA-IgA with deamidated gliadin peptides-IgG further improved diagnostic accuracy, while elevated TGA-IgA at diabetes onset predicted early celiac disease diagnosis.
Müller et al., J Clin Endocrinol Metab. 2025