Background: Children with type 1 diabetes (T1D) are at increased risk of celiac disease and other gluten-related disorders. Following our published validation of the AESKUCARE® Gluten Related Disorders (GRD) multiplex point-of-care immunoblot against ELISA, we continued the Ethiopian T1D screening program to characterize marker frequencies, antibody profiles and age-related patterns, with particular emphasis on combined antibody reactivity.
Methods: Children with confirmed T1D were screened using the AESKUCARE® GRD, simultaneously detecting IgA antibodies to tissue transglutaminase (tTG), tTG neo-epitopes, microbial transglutaminase (mTG), mTG neo-epitopes, TG3, deamidated gliadin peptides (DGP), gliadin and Frazer’s Fraction, together with total IgA. Samples negative for total IgA were excluded. Marker prevalence, co-positivity, antibody combinations and the association between age and number of positive markers were assessed.
Results: Of 126 children screened, 122 were IgA-sufficient and included. Median age was 11 years (IQR 7–13; range 2–17). At least one marker was positive in 42/122 children (34.4%). mTG neo was most frequent (16.4%), followed by mTG and DGP (13.9% each), whereas classical tTG was positive in 6.6%. tTG neo positivity was almost twice as frequent as tTG positivity (12.3% vs 6.6%); seven children were positive for both. Importantly, multiplex screening identified 17/122 children (13.9%) with tTG neo and/or mTG neo positivity despite negative or equivocal conventional tTG, including four equivocal tTG cases that would have remained inconclusive by conventional single-marker screening. Age was not associated with the number of positive markers (Spearman rₛ = −0.07, p = 0.45).
Conclusions: This ongoing program extends our prior assay validation into real-world cohort surveillance. Simultaneous assessment of classical and extended GRD markers provides a broader serological profile than tTG screening alone. Combining tTG with tTG neo, mTG neo and additional markers may improve risk stratification, particularly in equivocal cases, and identify children warranting confirmatory diagnostic work-up and longitudinal follow-up.