Gluten-Free Diet in Co-Existent Celiac Disease and Type 1 Diabetes Mellitus: Is It Detrimental or Beneficial to Glycemic Control, Vascular Complications, and Quality of Life?

Abstract

Celiac disease (CeD) is associated with type 1 diabetes mellitus (T1DM), and both have the same genetic background. Most patients with T1DM who develop CeD are either asymptomatic or have mild CeD-related gastrointestinal symptoms. Therefore, children affected by T1DM should undergo screening for asymptomatic CeD. The aim of this review is to highlight the influence of a gluten-free diet (GFD) on glycemic control, growth rate, microvascular complications, and quality of life in patients with T1DM and CeD. PubMed, Google Scholar, Web of Science, and Cochrane Central databases were searched. Reports reviewed were those published from 1969 to 2022 that focused on the interplay of T1DM and CeD and examined the effect of diet on glycemic control, growth rate, and quality of life. The most challenging aspect for a child with T1DM and CeD is that most GFD foods have a high glycemic index, while low glycemic index foods are recommended for T1DM. Interestingly, dietary therapy for CeD could improve the elevated HbA1c levels. Avoiding gluten added to a diabetic dietary regimen in T1DM patients might impose practical limitations and lead to important restrictions in the lifestyle of a young patient. Consequently, non-adherence to GFD in patients with T1DM and CeD is common. GFD in patients with T1DM and CeD seems to lower the incidence of micro- and macrovascular complications, but this requires further investigation. It seems that adherence to GFD in young patients with T1DM and CeD leads to regular growth and a stable body mass index without any negative effect on HbA1c or insulin requirements. Furthermore, the lipid profile and quality of life seem to have improved with the introduction of GFD.

Family‐based association of HLA‐DRB1 and DQB1 alleles and haplotypes in a group of Iranian Type 1 diabetes children

“…Studies have shown that all three autoimmune diseases somewhat share the genetic risk susceptibility based on HLA alleles inheritance. 36,37 Specifically, DRB1*03 and DRB1*04 allele groups play a role in Hashimoto's disease, 38 and DQB1*02 and DQB1*03:02 are associated with celiac disease. 39 Therefore, it appears that there is a strong correlation between hypothyroidism, celiac disease, and T1D in terms of genetic susceptibility particularly based on inheritance of HLA alleles.…”

Unveiling the Link: A Comprehensive Narrative Review of the Relationship Between Type 1 Diabetes Mellitus and Celiac Disease

“…Insulin shortage results from the autoimmune disease T1DM, caused by the death of the pancreatic beta cells producing insulin [8]. Insulin is a significant anabolic hormone that affects growth and impacts glucose, lipids, proteins, and minerals metabolisms.…”

“…Gluten, a protein in wheat, rye, barley, and other grains, can cause CD, an inflammatory condition that manifests as a multisystem inflammation with enteropathy as its hallmark [8]. Antireticulin (ARA), antiendomysial (EmA), antigliadin (AGA), and anti-tissue transglutaminase (ATG) autoantibodies are explicitly produced in response to gluten, and intestinal villi also shrink.…”

The Impact of Different Types of Rice and Cooking on Postprandial Glycemic Trends in Children with Type 1 Diabetes with or without Celiac Disease

“…The GFD normalizes the intestinal mucosa and often leads to the disappearance of antibodies but does not necessarily have an impact on glycemic control. Children and adolescents with T1D, with poor adherence to a gluten-free diet, may also have a reduced quality of life and poorer glycemic control [ 10 , 11 , 12 ]. Moreover, a GFD can be difficult to manage to maximize glycemic control with high glycemic index (GI) foods.…”

“…While some studies have shown that a GFD can have a positive impact on children’s growth, data on the impact of a GFD on glycemic control, HbA1c, and hypoglycemic episodes in subjects with T1D and CD are conflicting. A low GI diet can certainly be useful for reducing glucose excursions, but most GFD foods have a high GI that can rapidly raise blood glucose levels and risk major glycemic variability [ 11 ].…”