OBJECTIVE: To determine the effect of coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in asymptomatic children with Type 1 diabetes. METHODS: Data were compared in children with coeliac disease diagnosed by annual antibody screening and jejunal biopsy and treated with a gluten-free diet (n = 49) against individuals who were antibody negative (n = 49) matched for age, sex and duration of diabetes. RESULTS: No differences in growth were observed. In the years prior to diagnosis of coeliac disease, mean glycated haemoglobin (HbA(1c)) was lower in cases compared with control subjects [8.3 +/- 1.1% vs. 8.7 +/- 0.9%, P = 0.02 (mean +/- sd)]. In cases, HbA(1c) deteriorated 12 months from the start of a gluten-free diet to levels similar to control subjects (8.9 +/- 1.5% vs. 8.8 +/- 1.5%, P-value for analysis of variance = 0.9). In regression analysis, the diagnosis of coeliac disease and start of a gluten-free diet was associated with a rise in HbA(1c) in the first year of treatment [odds ratio 1.56 (95% confidence intervals 1.16-2.10), P = 0.003] after adjusting for insulin dose and regimen and other variables. CONCLUSIONS: In children with Type 1 diabetes, lower HbA(1c) prior to diagnosis of silent coeliac disease rises following treatment with a gluten-free diet to levels similar to those without coeliac disease. Although unproven, these observations may relate to abnormalities at the small bowel mucosa before the appearance of circulating coeliac antibodies.
OBJECTIVE: To determine the effect of coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in asymptomatic children with Type 1 diabetes. METHODS: Data were compared in children with coeliac disease diagnosed by annual antibody screening and jejunal biopsy and treated with a gluten-free diet (n = 49) against individuals who were antibody negative (n = 49) matched for age, sex and duration of diabetes. RESULTS: No differences in growth were observed. In the years prior to diagnosis of coeliac disease, mean glycated haemoglobin (HbA(1c)) was lower in cases compared with control subjects [8.3 +/- 1.1% vs. 8.7 +/- 0.9%, P = 0.02 (mean +/- sd)]. In cases, HbA(1c) deteriorated 12 months from the start of a gluten-free diet to levels similar to control subjects (8.9 +/- 1.5% vs. 8.8 +/- 1.5%, P-value for analysis of variance = 0.9). In regression analysis, the diagnosis of coeliac disease and start of a gluten-free diet was associated with a rise in HbA(1c) in the first year of treatment [odds ratio 1.56 (95% confidence intervals 1.16-2.10), P = 0.003] after adjusting for insulin dose and regimen and other variables. CONCLUSIONS: In children with Type 1 diabetes, lower HbA(1c) prior to diagnosis of silent coeliac disease rises following treatment with a gluten-free diet to levels similar to those without coeliac disease. Although unproven, these observations may relate to abnormalities at the small bowel mucosa before the appearance of circulating coeliac antibodies.
Authors: Kaziwe Mollazadegan; Michael Fored; Sigrid Lundberg; Johnny Ludvigsson; Anders Ekbom; Scott M Montgomery; Jonas F Ludvigsson Journal: Diabetologia Date: 2014-03-25 Impact factor: 10.122
Authors: Farid H Mahmud; Emilia N De Melo; Karima Noordin; Esther Assor; Kamaljeet Sahota; Jolie Davies-Shaw; Ernest Cutz; Gino Somers; Margaret Lawson; David R Mack; Patricia Gallego; Charlotte McDonald; Melanie D Beaton; Kevin Bax; Fred Saibil; Jeremy Gilbert; Susan Kirsch; Bruce A Perkins; Maria Cino; Eva Szentgyorgyi; Dror Koltin; Amish Parikh; Geetha Mukerji; Andrew Advani; Olivia Lou; Margaret A Marcon Journal: BMJ Open Date: 2015-05-11 Impact factor: 2.692