Age at Development of Type 1 Diabetes and Celiac Disease-Associated Antibodies and Clinical Disease in Genetically Susceptible Children Observed from Birth
- Satu Simell, MD (satu.simell{at}tyks.fi)1,2,
- Sanna Hoppu, MD, PHD1,4,
- Tuula Simell, MPH, PHD1,2,
- Marja-Riitta Ståhlberg, MD, PHD2,
- Markku Viander, MD, PHD3,
- Taina Routi, MD, PHD2,
- Ville Simell, MSC1,2,
- Riitta Veijola, MD, PHD1,5,
- Jorma Ilonen, MD, PHD1,6,7,
- Heikki Hyöty, MD, PHD1,8,
- Mikael Knip, MD, PHD1,4,9 and
- Olli Simell, MD, PHD1,2
- 1JDRF Center for Prevention of Type 1 Diabetes in Finland
- Departments of 2Pediatrics and
- 3Medical Microbiology, University of Turku, Turku, Finland
- 4Pediatric Research Center, Medical School, University of Tampere, and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- 5Department of Pediatrics, University of Oulu, Oulu, Finland
- 6Department of Clinical Microbiology, University of Kuopio, Kuopio, Finland
- 7Immunogenetics Laboratory, University of Turku, Turku, Finland
- 8Department of Virology, University of Tampere Medical School and Tampere University Hospital, Tampere, Finland
- 9Hospital for Children and Adolescents and Folkhälsan Research Institute, University of Helsinki, Helsinki, Finland
Abstract
Objective- To compare the ages and sequence in which antibodies associated with type 1 diabetes and celiac disease appear and overt diseases develop in children with a HLA-conferred susceptibility to both diseases.
Research design and methods- We observed 2,052 children carrying genetic risk for both type 1 diabetes and celiac disease from birth until the median age of 5.7 years and analyzed diabetes- and celiac disease-associated antibodies in serum samples collected at 3- to 12-month intervals. Diabetes was confirmed by WHO criteria and celiac disease by duodenal biopsies.
Results- Altogether 342 children seroconverted to positivity for at least one diabetes-associated autoantibody and 88 to positivity for at least one celiac disease-associated antibody at the median ages of 3.0 and 1.5 years, respectively (P < 0.001). If only children with biochemically defined diabetes-associated autoantibodies against insulin, glutamic acid decarboxylase or IA-2A protein (n=146), and children with tissue transglutaminase autoantibodies were compared (n = 86), the median seroconversion ages were 2.5 and 3.0 years (P = 0.011). Fifty-one children progressed to overt diabetes at 4.5 years and 44 children to celiac disease at 4.3 years (P = 0.257). Of the 19 children who developed both diabetes- and celiac disease-associated antibodies, three progressed both to diabetes and celiac disease.
Conclusions- Children with HLA-conferred susceptibility to type 1 diabetes and celiac disease develop celiac disease-associated antibodies mostly at a younger or the same age than diabetes-associated autoantibodies. Clinical diabetes and celiac disease are commonly diagnosed at the same median age.
Footnotes
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- Received July 3, 2009.
- Accepted December 22, 2009.
- Copyright © American Diabetes Association
