Response to Comment on Craig et al. Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes: International Comparison Across Three Continents. Diabetes Care 2017;40:1034–1040

Maltoni et al. (1) report a high prevalence (9.8%) of celiac disease (CD) in 2,164 youth with type 1 diabetes from five pediatric diabetes centers in northern Italy. This is considerably higher than in our recent report (3.5%) from three continents (U.K./Austria/Germany, U.S., and Australia) (2) and the pooled prevalence of 5.1% in a systematic review of CD in type 1 diabetes (3). Maltoni et al. propose that their higher rate of CD may be explained by more active screening programs in Italy. We agree that this is likely to be a contributing factor, as previous reports of high rates of coexisting CD and type 1 diabetes in Italy (4) and of CD in the general population may have heightened awareness of CD risk. It is of note, however, that we used a stringent definition of biopsy-proven CD and that a further …