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Clinical relevance and cost‐effectiveness of HLA genotyping in children with Type 1 diabetes mellitus in screening for coeliac disease in the Netherlands
Author(s) -
Elias J.,
HoorwegNijman J. J. G.,
Balemans W. A.
Publication year - 2015
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12658
Subject(s) - medicine , coeliac disease , genotyping , human leukocyte antigen , diabetes mellitus , type 1 diabetes , type 2 diabetes mellitus , hla dq , immunology , disease , gastroenterology , genotype , endocrinology , antigen , genetics , haplotype , biology , gene
Aims To investigate the clinical relevance and cost‐effectiveness of human leukocyte antigen ( HLA )‐genotyping in the Netherlands as a screening tool for the development of coeliac disease in children with Type 1 diabetes mellitus. Methods A retrospective analysis was performed in 110 children with Type 1 diabetes mellitus diagnosed between January 1996 and January 2013. All children were screened for coeliac disease using coeliac disease‐specific antibodies and HLA genotyping was performed in all children. Results One hundred and ten children were screened for coeliac disease, and coeliac disease could be confirmed in seven. Eighty‐six per cent of the children with Type 1 diabetes mellitus had one of the variants of HLA – DQ 2.5 and DQ 8. HLA genotypes observed in children with Type 1 diabetes mellitus children and coeliac disease were heterozygote DQ 2.5, homozygote DQ 2.5 and heterozygote DQ 2.5/ DQ 8. HLA genotyping in coeliac disease screening in children with Type 1 diabetes mellitus is more expensive than screening for coeliac disease with antibodies alone (€326 vs. €182 per child). Conclusions The risk of coeliac disease development in children with Type 1 diabetes mellitus is increased when they are heterozygote DQ 2.5/ DQ 8, homozygote or heterozygote DQ 2.5. The implementation of HLA genotyping as a first‐line screening tool has to be reconsidered because it is not distinctive or cost‐effective.