Table 3. Summary of mentioned articles about screening, diagnosis, and joint management of T1DM and CD.

T1DM, type 1 diabetes mellitus; CD, celiac disease; BPCD, biopsy-proven celiac disease; anti-tTG, anti-tissue transglutaminase antibodies; HR, hazard ratio; US, United States; HbA1c, hemoglobin A1c; CI, confidence interval; GFD, gluten-free diet

Author	Year	Design	Population	Global Sample	Results	Conclusions
Vajravelu et al. [42]	2018	Cohort Study	Individuals from  United Kingdom primary care database	9,180 patients diagnosed with T1DM between one and 35 years old with no previous diagnosis of CD	CD was diagnosed in 196 T1DM patients (2%) during the study.  A younger age at T1DM at diagnosis (HR 0.91 [95% CI 0.88-0.94]) and female sex (HR 3.19 [95% CI 1.39-7.34]) were associated with an increased risk of CD.	The greater risk of developing CD was found in those who were diagnosed of T1DM at a younger age and in the female sex.  Even though CD could develop in any age after T1DM, CD screening should be done in childhood and adulthood
Paul et al. [45]	2018	Prospective study	Children and adolescents at the Bristol Royal Hospital in England	2,035 children and adolescents with T1DM	157 T1DM children with no clinical symptoms were diagnosed with CD. 53.5% had anti-tTG >10× ULN (normal <10 IU/mL) and 89% were from high-risk groups; all of this percentage had a positive histological evidence of small bowel enteropathy	In children and adolescents, the levels of anti-tTG could be used as a noninvasive diagnostic method
Laitinen et al. [46]	2017	Cohort study	Children and adolescents at the Tampere University Hospital, Finland	520 children and adolescents between 0 and 17 years	Children from the screening had less decreased growth (p = 0.016) and symptomatology (p < 0.001) at diagnosis than the children that were tested after they had symptoms.	In the serological CD screening group, the patients were less affected by clinical symptoms and decreased growth than the ones diagnosed after clinical suspicions.  Also, both groups showed signs of malabsorption and similar advanced intestine mucosal damage. Therefore, a screening for celiac disease should be done in every patient with T1DM.
Unal et al. [47]	2021	Retrospective study	T1DM at the University of Health Sciences in Turkey	779 T1DM patients	The majority of CD cases (76.1%) were found at the diagnosis of T1DM and (21.7%) in the first five years, making together the 97.8% of cases diagnosed in the first five years of T1DM diagnosis; and the rest of the cases (2.2%) in the following years. However, the percentage of BPCD were just 6.9% at the time of the diagnosis. Additionally, in 23.3% cases, the positive autoantibodies spontaneously normalized without a GFD.	A serological test for diagnosis and follow-up is recommended, instead of biopsy-required diagnosis of CD.  Also, not initiating an immediate GFD therapy is suggested, especially in asymptomatic patients or with a mild value of autoantibodies test because it adds an additional burden in the diagnosed children and their families.
Kaur et al. [48]	2019	Randomized controlled trial	Patients with T1DM from India	320 patients with T1DM	The number of hypoglycemic episodes per month declined in the patients under a GFD (3.5 episodes at the beginning of the study versus 2.3 episodes at the sixth month). Also, the HbA1c was reduced by 0.73% in the GFD patients and elevated in 0.99% in the normal diet.	In patients with T1DM and CD, following a GFD could decrease the hypoglycemic episodes and could lead to an improved glycemic control.