Early diagnosis and treatment of celiac disease in type 1 diabetes. A longitudinal, case-control study.
OBJECTIVE
Subjects with type 1 diabetes mellitus (DM) are at increased risk to develop celiac disease (CD). However, most of the published investigations on the association between type 1 DM and CD are cross-sectional ones. In this paper, longitudinal data are presented on the effects of gluten-free diet (GFD) on growth and metabolic control in children and adolescents with type 1 DM screened for CD.


METHODS
Clinical records of 27 patients with type 1 DM+CD (7% of a population of 385 subjects with type 1 DM) were reviewed. The following variables were considered at the diagnosis of CD (T0) and after 24 (T24) and 48 (T48) months of GFD according to the length of available follow-up: weight, height, body mass index (BMI), Hb and HbA1c levels and per kg/day dose of insulin. Forty-three patients with type 1 DM alone, matched for sex, age and duration of diabetes were chosen as controls.


RESULTS
In patients with type 1 DM+CD, mean (SD) age at type 1 DM diagnosis was 8 (3.3) years. Median time interval between diagnosis of type 1 DM and of CD was 1.8 years (range 0.1-23.9 years). At T0 (n = 23), height and BMI z-score, HbA1c levels and daily insulin dose were comparable in type 1 DM+CD and in control subjects. Mean Hb concentration was significantly lower in subjects with type 1 DM+CD (12.6 (1.3) vs. 13.3 (0.7) g/dl, p < 0.05). At T24 (n = 22) and T48 (n = 16), no difference was detectable in height, BMI, HbAlc and insulin dose and also Hb concentration was comparable in both groups.


CONCLUSIONS
This study shows that, at diagnosis of CD, screened subjects with type 1 DM had only minor signs of malnutrition and metabolic disturbances were uncommon. Dietary treatment of CD can allow a growth and diabetes control comparable with subjects with diabetes alone.
Valletta
E
E
Paediatric Department, Pediatric Diabetes Unit, Policlinico G.B. Rossi, Verona. enrico.valletta@azosp.vr.it
Ulmi
D
D
Mabboni
I
I
Tomasselli
F
F
Pinelli
L
L
D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006452:Hemoglobinometry; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin