coeliac disease and type 1 diabetes mellitus
TRANSCRIPT
Coeliac Disease and Type 1 Diabetes Mellitus Questionnaire for Paediatric Healthcare Practitioners
Background 1) Where do you work?
Primary Care Secondary Care Tertiary Care
2) What is your role?
General Practitioner Community Paediatrician Consultant Paediatrician
Consultant PaediatricGastroenterologist
Consultant Paediatric Endocrinologist
Other (please specify)
3) How many of the following patients are currently managed in your trust?
a) Coeliac Disease
0-5 5-10 10-20 20+
b) Type 1 Diabetes Mellitus (T1DM)
0-20 20-50 50-100 100+
4) What (if any) of the following guidelines do you currently adhere to in managingpaediatric coeliac disease?
Internal NICE 2009 BSPGHAN 2005 ESPGHAN 2012
Other (please specify)
Screening (select all answers that apply)
5) Which of the following patients with T1DM should be tested for coeliac disease?
T1DM without gastrointestinal symptoms T1DM + gastrointestinal symptoms T1DM + absent HLA-DQ2/DQ8T1DM + known HLA-DQ2/DQ8 positivityOther (please specify)
6) When should you screen/test patients with T1DM for coeliac disease?
At point of diagnosis of T1DM At regular intervals following diagnosis of T1DM On appearance of additional gastrointestinal symptoms On deterioration in diabetic control On parental request Other (please specify)
Diagnosis 7) Which of the following tests do you currently use? (select all answers that apply)
a) In patients with T1DM and gastrointestinal symptoms
First Line (screen)
HLA-DQ2/8 Anti-TG2 Anti-EMA Biopsy Other
Second Line (to confirm)
HLA-DQ2/8 Anti-TG2 Anti-EMA Biopsy Other
Third Line (if required)
HLA-DQ2/8 Anti-TG2 Anti-EMA Biopsy Other
b) In asymptomatic patients with T1DM
First Line (screen)
HLA-DQ2/8 Anti-TG2 Anti-EMA Biopsy Other
Second Line (to confirm)
HLA-DQ2/8 Anti-TG2 Anti-EMA Biopsy Other
Third Line (if required)
HLA-DQ2/8 Anti-TG2 Anti-EMA Biopsy Other
8) During upper endoscopy, how many biopsies do you currently take from each part of theduodenum? (if applicable)
Duodenal bulb (D1) Second/third portion of the duodenum (D2/3)
Follow-Up and Management 9) What action would you currently take in patients with the following test results?
Recommend gluten-free
diet
Follow up with regular
repeatanti-TG IgA
No further CD-specific
action
a) Patients with T1DM andgastrointestinal symptoms
Anti-TG2 IgA negative
Anti-TG2 IgA positive, severe symptoms
Anti-TG2 IgA >10 ULN, anti-EMA positive, HLA positive
Anti-TG2 IgA <10 ULN, biopsy negative
Anti-TG2 IgA <10 ULN, biopsy positive
ReferAdditional
CD-specifictesting
9) (cont.) What action would you currently take in patients with the following test results?
10) Do you currently recommend a gluten-free diet to all asymptomatic patientswith T1DM diagnosed with coeliac disease?
YES NO
11) If YES, how do you explain the need for a gluten-free diet to these patients? (pleaserank in terms of importance; 1 - most important, 6 - least important)
Better glycaemic control Decreased risk of osteoporosis Decreased risk of lymphoma Decreased risk of later gastrointestinal symptoms Increased growth Increased fertility Other (please specify)
12) In your opinion, what is lacking/needs changing in current guidelines onthe diagnosis and management of coeliac disease in the paediatricpopulation?
Thank you for taking the time to complete this questionnaire
b) Asymptomatic patients with T1DMHLA negative
HLA positive, anti-TG2 IgA negative
HLA positive, anti-TG2 IgA <3 ULN, anti-EMA negative
HLA positive, anti-TG2 IgA <10 ULN, anti-EMA negative
HLA, anti-TG2 IgA >10 ULN and anti-EMA positive,
biopsy negative
Recommend gluten-free
diet
Follow up with regular
repeatanti-TG IgA
AdditionalCD-specific
testing
No further CD-specific
action Refer
Rachel Atherton, Medical [email protected]
Dr Matthias Zilbauer, Clinical Lecturer in Paediatric [email protected]
Department of Paediatric GastroenterologyBox 267, Addenbrooke's HospitalHills RoadCambridgeCB2 0QQ
Phone: 01223 217553