Mara Cerqueiro Bybrant - Coeliac Disease in Children and Adolescents with Type 1 Diabetes: Screening, Diagnosis and Prevalence

Hello and congratulations to your PhD,
People at the Department of Women’s and Children’s Health and others are interested to know a little more about your work.

Mara Bybrant
Mara Bybrant

What is your thesis about?

My doctoral thesis is about children and adolescents with two diseases: type 1 diabetes (T1D) and coeliac disease (CD). Both diseases are two very common chronic autoimmune diseases in childhood. The thesis compiles and discusses the results of four original research studies with regard to screening methods, diagnostic procedures and the prevalence of CD in Swedish children with T1D.

Which is the most important key result? 

The prevalence of CD in children and adolescents with T1D in Sweden was shown to be one of the highest in the world: every tenth child and adolescent with T1D in Sweden also had CD! Unlike the general population, Children with T1D were not affected by different gluten intake recommendations in infancy, during the so called Swedish CD epidemic, the prevalence was high both during and after the epidemic. Regarding diagnostic procedures: genetic testing with HLA was only useful in identifying the T1D population that was not at-risk of developing CD. We recommend repeated CD screening in children with T1D and we also suggested that guidelines for diagnosing CD in screened children should similarly apply to children with T1D, with regard to when biopsies can be avoided.

Is there something else you would like to add? Maybe something that surprised you during your PhD student journey?

I started the studies when there was no Swedish or international consensus about screening for CD in children and adolescents with T1D. The screening methods that were available internationally were certainly getting better, with more accurate tests and better techniques for taking biopsies.

Despite this, concerns had been highlighted about providing additional diagnoses of CD to children who already had T1D and this situation had led to comprehensive discussions by paediatric endocrinologists and gastroenterologists. It was against this background that I approached the research field of CD in T1D and came to play an active role in the design and execution of the studies included in my thesis. A decade of work, during which our results really made a difference in clinical practice.

How can this new knowledge contribute to improve women’s and children’s health?

When our first results were presented in our clinic, then in national and thereafter in international congress, showing a high prevalence of biopsy-proven CD in children with T1D, but also a doctors-delay in the diagnosis, both pediatric gastroenterologist and endocrinologist started to take the importance of screening T1D children into account. Consequently, together with the knowledge brought by other studies showing similar results and confirming that CD treatment do not make T1D worst, there was a paradigm shift: Screening for CD in the T1D pediatric population is the gold standard of national and international guidelines nowadays! The way for the CD screening and the diagnosis has been improved as well, and we suggest that biopsies are not necessary in some special cases. This approach is already acquired in the national CD guideline, and we hope it can also be added into international guidelines in the future.

Thank you very much Mara and good luck in the future.


Coeliac Disease in Children and Adolescents with Type 1 Diabetes: Screening, Diagnosis and Prevalence