Celiac Disease and Type 1 Diabetes: New Insights Into How Often They Occur Together

Children with Type 1 diabetes are screened routinely for celiac disease because the two conditions share genetic risk factors and occur together more often than by chance. However, researchers have known little about how often this co-occurrence happens or what it means for patients over time.

A new study looked at nearly 1,800 children with Type 1 diabetes treated at a single major medical center between 2009 and 2024. The team tracked who tested positive for celiac antibodies, who actually developed celiac disease, and what happened to those antibody levels over the years.

Among the nearly 1,800 children with Type 1 diabetes, 136 tested positive for anti-tissue transglutaminase (anti-TTG) antibodies—a key marker of celiac disease. Of those 136:

• 113 were confirmed to have celiac disease on biopsy • 15 had persistent positive antibodies but no confirmed celiac disease • 8 had a single borderline positive result

This means that most children with Type 1 diabetes and positive celiac antibodies do go on to develop confirmed celiac disease, but a meaningful minority do not—at least not during the study period.

In about 81% of cases, Type 1 diabetes was diagnosed first, with celiac disease detected later during routine screening. But in roughly 19% of cases, celiac disease came before Type 1 diabetes.

Children who had celiac disease before developing Type 1 diabetes stood out in important ways. They were more likely to report digestive symptoms, had stronger positive celiac antibody markers, and had higher blood sugar levels (HbA1c) when followed over time. This suggests that having both conditions may make blood sugar control more challenging.

The study confirms that celiac disease screening is warranted in children with Type 1 diabetes and shows that the two diseases can develop in either order. It also highlights that having both conditions may require closer attention to blood sugar management.

However, a positive celiac antibody test is not the same as a diagnosis of celiac disease. Some children with elevated antibodies never develop confirmed disease, and others maintain positive antibodies without symptoms. Your healthcare team should discuss what next steps—such as biopsy or follow-up testing—make sense for your individual situation.

Source: Pediatric diabetes. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.