No abstract

Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. RESEARCH DESIGN AND METHODSAsymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA 1c and continuous glucose monitoring over 12 months. RESULTSAdults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, N 5 1,298] vs. 4.7% [95% CI 3.4-5.9%, N 5 1,089], P 5 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N 5 27) or GCD (N 5 24). No HbA 1c differences were seen between the groups (10.14%, 1.5 mmol/mol; 95% CI 20.79 to 1.08; P 5 0.76), although greater postprandial glucose increases (4-h 11.5 mmol/L; 95% CI 0.4-2.7; P 5 0.014) emerged with a GFD. CONCLUSIONSCD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.Celiac disease (CD) is an immune reaction-mediated condition triggered by gluten, a protein found in wheat, barley, and rye. CD risk is increased in patients with type 1 diabetes and is characterized by a broad spectrum of presentations, including gastrointestinal symptoms, growth alterations, and anemia, but many patients are asymptomatic (1-4).Serologic screening for CD has high sensitivity and specificity, but few reports have evaluated CD rates and the impact of treatment with a gluten-free diet (GFD) in asymptomatic CD (aCD) patients with type 1 diabetes. The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) prospectively screened a large cohort of patients aged 8-45 years with subsequent engagement in a randomized, dietary treatment trial to evaluate changes in HbA 1c and glycemic variability.