A Longitudinal Study of the Effects of a Gluten-Free Diet on Glycemic Control and Weight Gain in Subjects With Type 1 Diabetes and Celiac Disease

Abstract

OBJECTIVE—To describe the longitudinal growth characteristics and glycemic control in type 1 diabetic children diagnosed with celiac disease and started on a gluten-free diet (GFD). RESEARCH DESIGN AND METHODS—Data on growth and glycemic control for 11 case subjects diagnosed with celiac disease (cd+ group) and started on a GFD were collected prospectively, and two control subjects without celiac disease matched for age, sex, and duration of diabetes (cd− group) were selected for comparison. RESULTS—In the period between diagnosis of type 1 diabetes and start of a GFD in the cd+ compared with the cd− group, BMI standard deviation score (SDS) was lower (–0.2 vs. 0.7, P = 0.015), as was HbA1c (8.9 vs. 9.8%, P = 0.002). In a regression model the cd+ group had lower BMI SDS (P < 0.001) and lower HbA1c (P = 0.04), independent of other variables. On a GFD, BMI SDS increased by 12 months in the cd+ group and then was no different than the cd− group (1.1 vs. 1.0, P = 0.11), whereas HbA1c improved further within case subjects compared with pre-GFD (8.9 vs. 8.3%, P = 0.002). On a GFD, case subjects in contrast to control subjects showed no deterioration in HbA1c during the years of puberty (8.3 vs. 10.0%, P = 0.022) CONCLUSIONS—In children with type 1 diabetes, untreated celiac disease resulted in lower BMI SDS and lower HbA1c. Recovery of BMI SDS with a GFD was associated with further improvement in HbA1c as compared with pre-GFD, with no expected deterioration in glycemic control during puberty. These apparent clinical benefits need confirming by larger studies.

Clinical Benefit of a Gluten-Free Diet in Type 1 Diabetic Children With Screening-Detected Celiac Disease

“…In accordance with this finding, some previous researchers have reported an impairment of growth in patients with celiac disease and type 1 diabetes compared with diabetic control subjects (3,9). In longitudinal studies of diabetic patients consuming a GFD, Amin et al (9) found an increase in BMI SDS, Saadah et al (10) showed an increase in weight-for-age z scores, and SanchezAlbisua et al (12) found an increase in height SDS in patients with good dietary compliance. On the other hand, Rami et al (11) and Westman et al (24) found no improvement in neither BMI SDS or height SDS on a GFD.…”

“…In the present study, A1C was almost unchanged in patients consuming a GFD. In a few studies, a decrease in A1C was seen in diabetic subjects after a GFD (9,12), whereas others could not demonstrate any improvements (10,11,25,26). However, A1C may not by itself reflect the metabolic control in diabetic subjects consuming a GFD.…”

Screening for Celiac Disease in Children With Type 1 Diabetes

“…Subclinical celiac disease, like symptomatic illness, may also cause growth failure and decreased weight gain (9,10), at least in some patients. A cross-sectional Australian study showed small reductions in height and weight Z score in 20 diabetic children with subclinical celiac disease compared with 40 diabetic control subjects matched for age, sex, and duration of diabetes (11), while an English study (12) reported decreased BMI Z scores but normal height in 11 diabetic children with celiac disease (10 subclinical and 1 classic) at the time of diagnosis (age 2.6 -17.3 years). Nevertheless, studies by Cacciari et al (13) and Bode et al (14) found that patients with subclinical celiac disease reach normal adult height even if untreated during childhood or adolescence.…”

“…Erratic absorption of nutrients in symptomatic celiac disease may increase the risk of severe hypoglycemia in diabetic patients; the effects on glycemic control and HbA 1c are more variable (7,8,12 and citations within).…”

The prevalence of coeliac disease in adult Danish patients with type 1 diabetes with and without nephropathy

“…However, the improvement in factors related to coeliac disease, such as growth, villous architecture and biochemical indices, also applies to patients with type 1 diabetes, and a trend towards increased BMI and tighter glycaemic control has been reported [8]. Another effect of the glutenfree diet is relief from non-specific symptoms such as tiredness and abdominal discomfort as well as a reduced risk of long-term complications such as infertility, osteoporosis and lymphomas of the small intestine.…”