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

Abstract

OBJECTIVE—This study was performed to 1) determine the prevalence of celiac disease in Danish children with type 1 diabetes and 2) estimate the clinical effects of a gluten-free diet (GFD) in patients with diabetes and celiac disease. RESEARCH DESIGN AND METHODS—In a region comprising 24% of the Danish population, all patients <16 years old with type 1 diabetes were identified and 269 (89%) were included in the study. The diagnosis of celiac disease was suspected in patients with endomysium and tissue transglutaminase antibodies in serum and confirmed by intestinal biopsy. Patients with celiac disease were followed for 2 years while consuming a GFD. RESULTS—In 28 of 33 patients with celiac antibodies, an intestinal biopsy showed villous atrophy. In 5 patients, celiac disease had been diagnosed previously, giving an overall prevalence of 12.3% (95% CI 8.6–16.9). Patients with celiac disease had a lower SD score (SDS) for height (P < 0.001) and weight (P = 0.002) than patients without celiac disease and were significantly younger at diabetes onset (P = 0.041). A GFD was obtained in 31 of 33 patients. After 2 years of follow-up, there was an increase in weight SDS (P = 0.006) and in children <14 years old an increase in height SDS (P = 0.036). An increase in hemoglobin (P = 0.002) and serum ferritin (P = 0.020) was found, whereas HbA1c remained unchanged (P = 0.311) during follow-up. CONCLUSIONS—This population-based study showed the highest reported prevalence of celiac disease in type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a GFD. We recommend screening for celiac disease in all children with type 1 diabetes.

At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study

“…Even if not all evinced complete normalization of antibodies during follow-up, a similar slow response in some celiac disease patients has also been noted elsewhere. 12,37 The present study confirmed the results of our previous survey-based study, in which the diagnostic approach also had no effect on dietary adherence, 15 and similar observations have recently been reported from the Netherlands and Sweden. 12,14 In contrast, in an earlier Italian study only 23% of screen-detected adolescents had satisfactory adherence to a gluten-free diet five years after the celiac disease diagnosis.…”

“…35 We have also shown these prominent complications to be present in otherwise asymptomatic patients, 23,36 and there is some evidence that the introduction of a gluten-free diet can improve poor growth and hemoglobin values also in screen-detected children. 37 Other possible complications which have been observed regardless of the clinical presentation of celiac disease are for instance low bone mineral density, dental enamel defects and elevated transaminases. 21,22,29,38 Further supporting the presence of advanced disease and risk of complications, the screen-detected children here had levels of celiac disease autoantibodies and severity of villous atrophy similar to those detected on clinical basis.…”

Usefulness of Symptoms to Screen for Celiac Disease

“…[11][12][13][14][15] However, these earlier studies have limitations because control groups were lacking, and the sensitivity, specificity, and predictive values of the suggested strategies therefore remain to be evaluated.…”

Novel trends in celiac disease

“…38 For type 1 diabetes, it has been shown that this condition is better treatable when CD is diagnosed and a GFD is followed. 39 Similarly, osteoporosis treatment shows stronger improvement in CD patients following GFD. 40 Other diseases which are associated with CD are Turner, Williams and Downs syndrome.…”