Navigating Autoimmune Overlap in Celiac Disease, With Daniel Mallon, MD

The overlap between celiac disease and other autoimmune disorders, especially type 1 diabetes, is an increasingly important area of clinical focus. As research continues to illuminate shared genetic pathways and early-life influences, clinicians are working to refine screening strategies and improve care for patients who may develop multiple autoimmune conditions.

In an interview with HCPLive at the 2025 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Annual Meeting, Daniel Mallon, MD, a pediatric gastroenterologist at Cincinnati Children’s Hospital, explained that about 5-10% of patients with type 1 diabetes will also develop celiac disease, while a smaller proportion of patients with celiac disease later develop type 1 diabetes, a crossover he says is driven largely by shared HLA class genetics and additional single nucleotide polymorphisms. He notes that these common genetic features also link other autoimmune diseases like autoimmune thyroid disease to celiac disease and type 1 diabetes.

Mallon also highlights potential early-life environmental contributors, including viral infections, the timing of gluten introduction, and the amount of gluten consumed in toddler years. These factors, he says, may influence the development not only of celiac disease but also of other autoimmune conditions such as type 1 diabetes.

“When physicians, primary care doctors, endocrinologists are on the lookout for celiac disease, they obviously should be looking for the classic symptoms, malabsorption, diarrhea, weight loss, vomiting, GI symptoms, abdominal pain,” Mallon said. “But there are also other more subtle things, like slight delays in growth, or a great proportion of those patients have no symptoms at all, even when you ask a lot of questions.”

He goes on to note particular challenges in diagnosing celiac disease in patients with type 1 diabetes. He explains that false-positive serologies are common, making evaluation by a pediatric gastroenterologist essential. Such specialists can navigate the nuances of laboratory testing and help families manage the emotional burden of adding a second chronic condition.

Mallon further emphasizes why early identification matters, explaining how the combination of both conditions introduces unique risks that require tailored follow-up care. He also describes growing interest in screening patients with celiac disease for type 1 diabetes.

“If we can identify the patients before they get sick, then we can prevent DKA in 80 to 90% of those patients, which is an enormous help to their overall health,” he said.

Editors’ note: Mallon reports no relevant disclosures.

References

1. Mallon D. Crossroads Between Celiac Disease and Other Autoimmune Conditions. Session presented at 2025 NASPGHAN Annual Meeting. November 5-9, 2025. Chicago, Illinois.

2. UChicago Medicine. Are pediatric celiac disease and type 1 diabetes related? May 1, 2023. Accessed December 8, 2025. https://www.uchicagomedicine.org/forefront/pediatrics-articles/are-pediatric-celiac-disease-and-type-1-diabetes-related