Coexisting Type 1 Diabetes, Persistent Symptoms, and Financial Issues Associate With Poorer Adherence to a Gluten-Free Diet in Celiac Disease After Transition From Pediatrics to Adult Care

Abstract

PurposeWe evaluated adherence to a gluten-free diet and associated factors in adult celiac disease patients diagnosed in childhood.MethodsComprehensive medical data on 955 pediatric celiac disease patients was collected and study questionnaires sent to 559 who were now adults. All variables were compared between strictly adherent and non-adherent patients.ResultsAltogether 237 adults (median age 27 years, 69% women) responded to the questionnaires a median of 18 (range 3–51) years after the childhood diagnosis. Altogether 78% were reportedly adherent and 22% non-adherent. The non-adherent patients had more concomitant type 1 diabetes (18% vs. 4%, p = 0.003), whereas the groups did not differ in demographic data or clinical and histological features at diagnosis, or in short-term dietary adherence. In adulthood, non-adherent patients found gluten-free diet more challenging (39% vs. 17%, p < 0.001) and had higher prevalence (39% vs. 19%, p = 0.004) and severity of symptoms. The main motivation factors for dietary adherence were attempts to avoid symptoms and complications, but these were considered less important and price of gluten-free products more important among non-adherent patients. Adherent and non-adherent patients did not differ in socioeconomic or lifestyle factors, comorbidities other than type 1 diabetes, self-reported general health, health concerns, follow-up, or in quality of life.ConclusionMost originally pediatric celiac disease patients reported strict dietary adherence in adulthood. However, particularly those with concomitant type 1 diabetes, persistent symptoms or financial issues may require attention during the transition from pediatric to adult care.

Association of concomitant autoimmunity with the disease features and long-term treatment and health outcomes in Celiac disease

“…Furthermore, subjects recruited via the CeD society are likely more aware of the importance of a strict GFD. In fact, we recently also observed lower adherence in a special group of adult T1D patients diagnosed with CeD in childhood ( 8 ). Taken together, despite the good GFD adherence even among the non-followed-up patients here, we consider systematic long-term surveillance particularly important in subjects with concomitant AIDs.…”

“…Nevertheless, this approach remains debatable, particularly in the absence of data on the long-term prognosis of undetected CeD in AID patients. Acceptance of the treatment—strict and life-long gluten-free diet (GFD)—in these often asymptomatic individuals may also be suboptimal ( 8 ). Therefore, the current screening recommendations are inconsistent and are based primarily on the increased prevalence figures ( 9 – 12 ).…”

Sleep quality and sex-related factors in adult patients with immune-mediated diabetes: a large cross-sectional study

“…The analysis performed separately in males and females confirmed the higher prevalence of psychiatric disorders in patients with altered sleep quality only among females, whereas the larger prevalence of celiac and autoimmune diseases was identified only in men with low quality of sleep. Previous studies showed that patients with celiac disease may have a variable proportion of altered sleep quality; additionally, males showed a worse adherence to gluten-free diet than females [31] and patients non-adherent to gluten-free diet have more frequently T1D [32]. Recent data also highlighted that gluten-free diet may improve sleep quality [33].…”