title: Potential beneficial effects of a gluten-free diet in newly diagnosed children with type 1 diabetes: a pilot study.
abstract: OBJECTIVE
  Gluten-free diet has shown promising effects in preventing type 1 diabetes (T1D) in animals as well as beneficial effects on the immune system. Gluten-free diet at diabetes onset may alter the natural course and outcome of autoimmune diseases such as T1D.
  
  
  METHODS
  In a 12-month study, 15 children newly diagnosed with T1D were instructed to follow a gluten-free diet. Questionnaires were used to evaluate adherence to the gluten-free diet. Partial remission (PR) was defined by insulin dose-adjusted A1c (IDAA1c) ≤9 or stimulated C-peptide (SCP) >300 pmol/L measured 90 min after a liquid mixed meal at the inclusion, six and 12 months after onset. The intervention group was compared with two previous cohorts. Linear mixed models were used to estimate differences between cohorts.
  
  
  RESULTS
  After 6 months, more children on a gluten-free diet tended to have SCP values above 300 pmol/L compared to the European cohort (p = 0.08). The adherence to a gluten-free diet decreased during the 12-month study period. After 1 year there was no difference in SCP levels or percentage in remission according to SCP (p > 0.1). Three times as many children were still in PR based on IDAA1c (p < 0.05). Twelve months after onset HbA1c were 21 % lower and IDAA1c >1 unit lower in the cohort on a gluten-free diet compared to the two previous cohorts (p < 0.001).
  
  
  CONCLUSIONS
  Gluten-free diet is feasible in highly motivated families and is associated with a significantly better outcome as assessed by HbA1c and IDAA1c. This finding needs confirmation in a randomized trial including screening for quality of life. (Clinicaltrials.gov number NCT02284815).
authors.affiliation: Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Jannet
authors.initials: J
authors.lastname: Svensson
authors.affiliation: Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Stine Møller
authors.initials: SM
authors.lastname: Sildorf
authors.affiliation: Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade, 1014 Copenhagen, Denmark.
authors.forename: Christian B
authors.initials: CB
authors.lastname: Pipper
authors.affiliation: Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Julie N
authors.initials: JN
authors.lastname: Kyvsgaard
authors.affiliation: Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Julie
authors.initials: J
authors.lastname: Bøjstrup
authors.affiliation: Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Flemming M
authors.initials: FM
authors.lastname: Pociot
authors.affiliation: Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Children and Adolescents, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Henrik B
authors.initials: HB
authors.lastname: Mortensen
authors.affiliation: The Bartholin Institute, Rigshospitalet, Copenhagen Biocenter, Ole Maaløes Vej 5, 2200 Copenhagen N, Denmark.
authors.forename: Karsten
authors.initials: K
authors.lastname: Buschard
keywords: Gluten; Insulin dose-adjusted HbA1c; Remission phase; Type 1 diabetes