P-329: Higher celiac autoimmune burden is associated with higher HbA1c in children and adolescents with type 1 diabetes: preliminary results from the prospective multicentre CELDIA-20 study
F Di Candia, A Fierro, A Casertano, M Bassi, R Bonfanti, V Cherubini, L De Sanctis, B Felappi, R Franceschi, D Iafusco, B Iovane, D Lopresti, C Maffeis, G Maltoni, B Piccini, E Piccinno, B Predieri, I Rabbone, C Ripoli, R Roppolo, G Salzano, R Schiaffini, G Tornese, E MozzilloAbstract
Introduction
Celiac disease (CD) is one of the most common autoimmune comorbidities in youth with type 1 diabetes (T1D). Although retrospective studies have suggested an association between CD and suboptimal metabolic control, prospective evidence investigating whether anti-tissue transglutaminase IgA (TTG-IgA) titres are associated with HbA1c at CD diagnosis is lacking.
Objectives
To investigate the association between TTG-IgA titres and HbA1c at the time of CD diagnosis, and to describe the prevalence and early incidence of CD in children and adolescents with T1D.
Methods
CELDIA-20 is an ongoing multicentre prospective study enrolling children diagnosed with T1D in Italy between 2020 and 2021. This preliminary analysis included participants from six paediatric diabetes centres. Children diagnosed with CD before, concomitantly with, or within five years after T1D onset were included. TTG-IgA titres were expressed relative to the upper limit of normal and log-transformed before analysis.
Results
Among 668 children with newly diagnosed T1D, 56 developed CD. Higher TTG-IgA titres were associated with higher HbA1c at CD diagnosis. Log-transformed TTG-IgA titres showed a moderate positive correlation with HbA1c (Spearman’s ρ = 0.465, p = 0.003). Linear regression showed that each 1% increase in HbA1c was associated with a 0.239-unit increase in log(TTG-IgA) (β = 0.239, p = 0.009), with HbA1c explaining 17.6% of the variability in antibody titres (R2 = 0.176). CD prevalence at T1D onset was 4.6%, while the cumulative incidence of newly diagnosed CD during the first five years was 3.3%.
Conclusions
In this preliminary analysis of the prospective CELDIA-20 cohort, higher TTG-IgA titres were associated with higher HbA1c at CD diagnosis. These findings suggest that the magnitude of celiac autoimmunity may parallel metabolic dysregulation in children and adolescents with T1D. Longitudinal analyses of the complete CELDIA-20 cohort will determine whether celiac autoimmune burden is also associated with other clinical outcomes.