Systematic Review With Meta-analysis

Associations Between Coeliac Disease and Type 1 Diabetes

P. Elfström; J. Sundström; J. F. Ludvigsson


Aliment Pharmacol Ther. 2014;40(10):1123-1132. 

In This Article

Abstract and Introduction


Background In the past decade, a number of population-based studies have examined the prevalence of coeliac disease in individuals with type 1 diabetes but prevalences have differed considerably.

Aim To examine the prevalence of coeliac disease in individuals with type 1 diabetes.

Methods A systematic review of English-language articles published in PubMed Medline between 2000 and May 2014. Search terms included 'celiac disease' or 'coeliac disease' and 'diabetes mellitus'.

Studies were selected with at least 100 individuals with type 1 diabetes being screened for coeliac disease where the coeliac diagnosis was later confirmed through small intestinal biopsy.

Data synthesis used random-effects inverse variance-weighted models, and metaregression was used to examine heterogeneity in subgroups.

Results A pooled analysis, based on 26,605 patients with type 1 diabetes, found a prevalence of biopsy-confirmed coeliac disease of 6.0% (95% CI = 5.0–6.9%). Heterogeneity was large (I 2 = 93.2%). The prevalence was lower in adults with type 1 diabetes (2.7%), and in mixed populations with both children and adults with type 1 diabetes (4.7%) than in children (6.2%) with type 1 diabetes (P < 0.001). Additional subgroup analyses could not explain the large variation in coeliac disease prevalence between studies.

Conclusion More than one in twenty patients with type 1 diabetes have biopsy-verified coeliac disease. This prevalence is high enough to motivate screening for coeliac disease among patients with type 1 diabetes.


Coeliac disease (CD) is a chronic immune-mediated disease characterised by inflammation and villous atrophy (VA) in the small intestine.[1] Although the prevalence of CD varies widely in a global perspective,[2] a recent large-scale study from Finland, Germany, Italy and the UK reported an overall prevalence of 1%.[3]

The prevalence of CD in type 1 diabetes (T1D) has varied between 1.6%[4] and >10%.[5] Despite contradicting data on the prevalence of CD in T1D, screening for CD is often recommended in patients with T1D.[6]

Few studies have examined the risk of T1D in patients initially diagnosed with CD.[7] In a cohort of in-patients with CD, the relative risk of subsequent T1D diagnosed before the age of 20 years was doubled.[7]

The purpose of this paper was to review the association between T1D and CD, with particular focus on the prevalence of CD in T1D patients. We hypothesised that CD occurs in about 1 in 20 patients with T1D. A second objective was to examine variations in CD prevalence in subgroups of T1D patients.