Incidence and Associated Risk Factors of Coeliac Disease in Children Newly Diagnosed With Type 1 Diabetes: A 5‐Year Nationwide Prospective Study From Kuwait
Hessa Al‐Kandari, Wafaa Al‐Qabandi, Mohammed T. Hudda, Aisha Alsaqabi, Lujain D. AlAbduljaleel, Rawand Rafat Toma, Ahlam Mustafa, Fawaz Al‐Refaee, Dalia Al‐AbdulrazzaqABSTRACT
Aims
Kuwait has one of the highest global incidences of childhood type 1 diabetes (T1D), yet little is known about the burden of coeliac disease (CD) in this population. We aimed to determine the prevalence/incidence of CD in children newly diagnosed with T1D in Kuwait and identify associated risk factors.
Methods
In this prospective cohort study, all 1938 children (≤ 14 years) diagnosed with T1D in Kuwait between 2011 and 2017 were enrolled and followed for 5 years post‐diagnosis. CD development was defined by intestinal biopsy confirmation. Cox univariable regression models quantified associations between several characteristics at T1D diagnosis (age, sex, DKA, height z‐score and BMI z‐score) and incident CD risk.
Results
Four baseline CD cases were excluded. Of the remaining 1934 children, 65 (3.4%) developed CD during follow‐up. The median time to CD diagnosis was 1.5 years; 40% were diagnosed within the first year. The incidence rate within the first year following T1D diagnosis was 1.35 (95% CI 0.92–1.99) per 100 person‐years and generally declined over subsequent years of follow‐up. While age at diagnosis showed no clear effect shortly after T1D diagnosis, older age was associated with progressively lower CD risk over longer follow‐up, with the risk of CD being 33% lower per one‐year increase in age at diagnosis by 5 years of follow‐up; no other baseline factors investigated were significant.
Conclusion
This nationwide prospective study highlights the burden and timing of biopsy‐confirmed CD after T1D onset. CD occurred most frequently during the early years after T1D diagnosis, with a higher risk among younger children, supporting particular attention to screening in these groups.