A longitudinal study of the effects of a gluten-free diet on glycemic control and weight gain in subjects with type 1 diabetes and celiac disease.
OBJECTIVE
To describe the longitudinal growth characteristics and glycemic control in type 1 diabetic children diagnosed with celiac disease and started on a gluten-free diet (GFD).


METHODS
Data on growth and glycemic control for 11 case subjects diagnosed with celiac disease (cd(+) group) and started on a GFD were collected prospectively, and two control subjects without celiac disease matched for age, sex, and duration of diabetes (cd(-) group) were selected for comparison.


RESULTS
In the period between diagnosis of type 1 diabetes and start of a GFD in the cd(+) compared with the cd(-) group, BMI standard deviation score (SDS) was lower (-0.2 vs. 0.7, P = 0.015), as was HbA(1c) (8.9 vs. 9.8%, P = 0.002). In a regression model the cd(+) group had lower BMI SDS (P < 0.001) and lower HbA(1c) (P = 0.04), independent of other variables. On a GFD, BMI SDS increased by 12 months in the cd(+) group and then was no different than the cd(-) group (1.1 vs. 1.0, P = 0.11), whereas HbA(1c) improved further within case subjects compared with pre-GFD (8.9 vs. 8.3%, P = 0.002). On a GFD, case subjects in contrast to control subjects showed no deterioration in HbA(1c) during the years of puberty (8.3 vs. 10.0%, P = 0.022)


CONCLUSIONS
In children with type 1 diabetes, untreated celiac disease resulted in lower BMI SDS and lower HbA(1c). Recovery of BMI SDS with a GFD was associated with further improvement in HbA(1c) as compared with pre-GFD, with no expected deterioration in glycemic control during puberty. These apparent clinical benefits need confirming by larger studies.
Amin
Rakesh
R
University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK.
Murphy
Nuala
N
Edge
Julie
J
Ahmed
Marion L
ML
Acerini
Carlo L
CL
Dunger
David B
DB
D000293:Adolescent; D017668:Age of Onset; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002446:Celiac Disease / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003927:Diet, Diabetic; D005260:Female; D005983:Glutens; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D012016:Reference Values; D015430:Weight Gain
D001786:Blood Glucose; D005983:Glutens