Children diagnosed with type 1 diabetes (T1D) face more than just managing their blood sugar. They are also at a higher lifelong risk of developing celiac disease. Because of this, regular screening is recommended to catch celiac disease early in kids with T1D.
A new article published in Clinical Chemistry takes a closer look at how blood tests for celiac disease can be used more effectively in this group of patients. In celiac disease, elevated TTG-IgA antibodies are often the first step in the diagnostic process. If blood levels TTG-IgA levels are elevated, patients are typically sent for a biopsy to confirm celiac disease. However, this can be a bit more complicated in kids with T1D. In children with T1D, TTG-IgA antibody levels can fluctuate, and there hasn’t been a clear cutoff for when a biopsy is truly necessary.
Researchers studied nearly 600 children with T1D and found that using a cutoff of 6 times the normal limit gave the best balance of accuracy, which performed better than the older cutoff of 11 times the normal limit. The study also showed that kids who developed celiac disease soon after being diagnosed with T1D often had higher antibody levels right away, while those who developed celiac disease later had lower levels in the beginning. This highlights the importance of testing at the time of T1D diagnosis and continuing to monitor regularly, even if early test results aren’t extremely high.
“Our article looked at recent work investigating serologic assays’ efficacies in pediatric patients with type 1 diabetes. We found that recent data such as those seen in Muller et al’s study (2025) suggest that lower transglutaminase elevations can portend celiac disease in this population than previously thought, and the disease remains considerably prevalent among patients with T1d. As such it is crucial to actively evaluate for CeD in T1d patients, and the serologies provide an excellent tool for doing so,” said study author Dr. Andrew M. Ford.
For families, the key takeaway is that regular screening matters, and doctors are working to fine-tune how these tests are used so children with both T1D and celiac disease can be diagnosed as early and accurately as possible.