Benefit of Gluten-Free Diet in Type 1 Diabetic Children With Celiac Disease

Diabetes :: Benefit of Gluten-Free Diet in Type 1 Diabetic Children With Celiac Disease

Patients with celiac disease showed clinical improvements with a Gluten-Free Diet, GFD reported in a Denmark study. This study was performed to 1) determine the prevalence of celiac disease in Danish children with type 1 diabetes and 2) estimate the clinical effects of a gluten-free diet (GFD) in patients with diabetes and celiac disease.

Coeliac disease or celiac disease is an autoimmune disorder of the small bowel that occurs in genetically predisposed individuals in all age groups after early infancy. Symptoms may include diarrhoea, failure to thrive (in children) and fatigue, but these may be absent and associated symptoms in all other organ systems have been described. It affects approximately 1% of Caucasian populations, though it is significantly underdiagnosed. A growing portion of diagnoses are being made in asymptomatic persons as a result of increasing screening.

In a region comprising 24% of the Danish population, all patients <16 years old with type 1 diabetes were identified and 269 (89%) were included in the study. The diagnosis of celiac disease was suspected in patients with endomysium and tissue transglutaminase antibodies in serum and confirmed by intestinal biopsy. Patients with celiac disease were followed for 2 years while consuming a GFD.

In 28 of 33 patients with celiac antibodies, an intestinal biopsy showed villous atrophy. In 5 patients, celiac disease had been diagnosed previously, giving an overall prevalence of 12.3% (95% CI 8.6?16.9). Patients with celiac disease had a lower SD score (SDS) for height (P < 0.001) and weight (P = 0.002) than patients without celiac disease and were significantly younger at diabetes onset (P = 0.041). A GFD was obtained in 31 of 33 patients. After 2 years of follow-up, there was an increase in weight SDS (P = 0.006) and in children <14 years old an increase in height SDS (P = 0.036). An increase in hemoglobin (P = 0.002) and serum ferritin (P = 0.020) was found, whereas HbA1c remained unchanged (P = 0.311) during follow-up.

This population-based study showed the highest reported prevalence of celiac disease in type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a GFD. We recommend screening for celiac disease in all children with type 1 diabetes.

Clinical Benefit of a Gluten-Free Diet in Type 1 Diabetic Children With Screening-Detected Celiac Disease
A population-based screening study with 2 years? follow-up
Dorte Hansen, MD, PHD1, Bendt Brock-Jacobsen, MD, DMS1, Elisabeth Lund, MD2, Christina Bj?rn, MD3, Lars P. Hansen, MD4, Christian Nielsen, CS5, Claus Fenger, MD, DMS6, S?ren T. Lillevang, MD, PHD5 and Steffen Husby, MD, DMS1
1 Department of Pediatrics, Odense University Hospital, Odense, Denmark
2 Department of Pediatrics, Kolding Hospital, Kolding, Denmark
3 Deparment of Pediatrics, Esbjerg Hospital, Esbjerg, Denmark
4 Department of Pediatrics, Sonderborg Hospital, Sonderborg, Denmark
5 Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
6 Department of Pathology, Odense University Hospital, Odense, Denmark

Diabetes Care, November 2006.