title: Celiac disease in children with type 1 diabetes: impact of gluten free diet on diabetes management.
abstract: Background and aim of the work the coexistence of Type 1 Diabetes (T1D) and celiac disease (CD) has been long established.
  
  
  METHODS
  Between January 2000 and December 2009, biopsy-proven CD was diagnosed in 12 children with T1D, giving a prevalence of 4.8 % in our out-patient clinic population. For each patient with coexisting T1D and CD, two control subjects with T1D and without CD who matched for age, sex and duration of diabetes were chosen. Prospective study follow up lasted 24 months. At the enrolment time, and at 2-month intervals, time from diagnosis of T1D to diagnosis of CD, presence of gastrointestinal symptoms, HbA1c value, body mass index (BMI), Height and Weight SDS were collected by a single observer. Daily insulin requirements were also retained.
  
  
  RESULTS
  In 3 children, CD predated the onset of T1D and these children were excluded from the analysis. The 9 children who subsequently developed CD became earlier diabetic than control group (p=0.002). Eight of these children had CD diagnosis within 1 year after T1D onset. Seven out of 9 children were positive for TTG antibodies and all were positive for EMA. A significant increase in insulin requirement was found in CD children after 1 year of GFD (p= 0.02). The mean HbAlc value in CD children was higher than in the control subjects (p<0.01).A significant increase in the insulin requirement after 1 year in the GFD compliant children was found. There was a significant improvement in height-SDS after institution of GFD in the GFD-compliant children. Families of children with both T1D and CD reported higher burden than those affected by T1D only (p=0.001). The health care providers perceived family burden to increase with CD appearance (p<0.05).
  
  
  CONCLUSIONS
  Our study supports the importance of screening for CD in children with T1D 1. The early treatment with GFD of biopsy-confirmed CD children promotes a significant catch-up growth and prevents a growth failure during the follow-up.
authors.affiliation: Regional Centre for Children and Adolescents with Diabetes, Department of Paediatrics, University Hospital of Parma, Parma, Italy.
authors.forename: Ivonne
authors.initials: I
authors.lastname: Sponzilli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Chiari
authors.forename: Brunella
authors.initials: B
authors.lastname: Iovane
authors.forename: Chiara
authors.initials: C
authors.lastname: Scarabello
authors.forename: Dimitra
authors.initials: D
authors.lastname: Gkliati
authors.forename: Giorgia
authors.initials: G
authors.lastname: Monti
authors.forename: Lavinia
authors.initials: L
authors.lastname: Fanciullo
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: de'Angelis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vanelli
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D055050:Diet, Gluten-Free; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin