P-122: Assessing the impact of universal celiac disease screening in type 1 diabetes: a shift from symptom-based to routine screening in a pediatric tertiary care diabetes program
M El Masri, E B Goldbloom, A Ahmet, N Mitsakakis, E Sucha, C ZuijdwijkAbstract
Introduction
Celiac disease (CD) frequently co-occurs with type 1 diabetes (T1D) but is often asymptomatic, causing diagnostic delays. Screening practices vary across T1D clinics. While the 2018 Diabetes Canada guidelines supported only symptom-based screening, the 2022 International Society for Pediatric and Adolescent Diabetes guidelines recommend routine screening for all children with T1D, recognizing the clinical impact of asymptomatic CD. In May 2023, our clinic transitioned from symptom-based to routine CD screening following a 9-month transitional phase for physician education and system-level change.
Objectives
To evaluate the impact of routine (vs. symptom-based) CD screening on the incidence of newly diagnosed CD in children with T1D in a tertiary care diabetes program. This was assessed by comparing the incidence of gastroenterologist- confirmed CD diagnoses in two phases: pre-implementation (August 10, 2020 to August 9, 2022) and post-implementation (May 8, 2023 to May 7, 2025) of a universal screening program.
Methods
We conducted a retrospective cohort study of children (< 18 years) with T1D followed at a pediatric type 1 diabetes clinic in Canada. Incidence rates (IR) were estimated as number of CD diagnoses per 1,000 person-years separately for each phase. Pre- and post- implementation IRs were compared using Wald method. CD diagnosis was defined as a diagnosis established by a gastroenterologist.
Results
Among 1,209 children screened across both phases (46% female; median age at T1D diagnosis 8.25 years), routine screening was associated with a 2.7-fold increase in the incidence rate of CD diagnosis compared with the preceding symtom-based screening (8.6 vs. 23.1 per 1000 person years, respectively; p=0.001).
Conclusions
Transitioning to routine CD screening significantly increased disease detection, identifying cases that likely would have remained unrecognized under symptom-based protocols. These findings support the implementation of universal CD screening in children with T1D.