Serological testing for coeliac disease in Type 1 diabetes mellitus: is immunoglobulin A level measurement necessary?. Issue 7 (5th April 2013)

• Record Type: Journal Article
• Authors: Kurien, M.; Leeds, J. S.; Hopper, A. D.; Wild, G.; Egner, W.; Tesfaye, S.; Hadjivassiliou, M.; Sanders, D. S.
• Is Part Of: Diabetic medicine. Volume 30:Issue 7(2013:Jul.)
• Page Start: 840
• Page End: 845
• Publication Date: 2013-04-05
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12163
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" xml:lang="en" id="dme12163-abs-0001"> <title>Abstract</title> <sec id="dme12163-sec-0001" sec-type="section"> <title>Aims</title> <p>Immunoglobulin A (IgA) measurement is advocated when case finding for coeliac disease in patients with Type 1 diabetes mellitus. Currently, there is a paucity of contemporary studies assessing IgA deficiency in Type 1 diabetes. This study evaluates the prevalence of IgA deficiency in individuals with Type 1 diabetes, compared with patients with coeliac disease and control subjects. In addition, we evaluate whether routine IgA measurement is justifiable when case finding for coeliac disease in patients with Type 1 diabetes.</p> </sec> <sec id="dme12163-sec-0002" sec-type="section"> <title>Methods</title> <p>All patients were assessed using IgA endomysial antibodies, IgA anti‐tissue transglutaminase antibodies and total IgA levels. Altogether, 2434 individuals were tested: 1000 patients with Type 1 diabetes, 234 patients with coeliac disease and 1200 population control subjects. Definitive IgA deficiency was defined as total IgA levels < 0.07 g/l.</p> </sec> <sec id="dme12163-sec-0003" sec-type="section"> <title>Results</title> <p>The prevalence of IgA deficiency was significantly more common in patients with Type 1 diabetes (0.9%, <italic>n</italic> = 9/1000; <italic>P</italic> = 0.036) and coeliac disease (1.29%, <italic>n</italic> = 3/234; <italic>P</italic> = 0.041) when compared with population control subjects (prevalence of 0.17%, 2/1200). No statistical difference between Type 1 diabetes and coeliac disease for IgA deficiency was identified (<italic>P</italic> = 0.87). Of patients in the group with Type 1 diabetes, 3.3% (33/1000) had coeliac disease, and of those only one patient had IgA deficiency leading to an antibody‐negative presentation. Both IgA‐deficient individuals within the population control subjects had normal duodenal biopsies and no relevant symptoms.</p> </sec> <sec id="dme12163-sec-0004" sec-type="section"> <title>Conclusions</title> <p>IgA deficiency is more common in Type 1 diabetes compared with population control subjects. Despite this, very few individuals with Type 1 diabetes and IgA deficiency appear to have villous atrophy on biopsy. These outcomes question the practice of routine IgA measurement when case finding for coeliac disease in patients with Type 1 diabetes.</p> </sec> </abstract>