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.
OBJECTIVE
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.


METHODS
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.


RESULTS
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 HbA(1c) remained unchanged (P = 0.311) during follow-up.


CONCLUSIONS
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.
Hansen
Dorte
D
Department of Pediatrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. dorte.hansen@dadlnet.dk
Brock-Jacobsen
Bendt
B
Lund
Elisabeth
E
Bjørn
Christina
C
Hansen
Lars P
LP
Nielsen
Christian
C
Fenger
Claus
C
Lillevang
Søren T
ST
Husby
Steffen
S
D000293:Adolescent; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy* / Q000453:epidemiology*; D003927:Diet, Diabetic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens; D006801:Humans; D008297:Male; D008403:Mass Screening; D015995:Prevalence
D005983:Glutens