Impact of a Gluten-free Diet on Several Growth Parameters in Children with Type 1 Diabetes Mellitus and Celiac Disease in Western Uttar Pradesh, India

Abstract

Background. Celiac disease is frequently associated with uncontrolled blood sugar and impaired linear growth in a child with type 1 diabetes mellitus.Objective. To study the impact of a gluten-free diet on several growth parameters in children with type 1 diabetes mellitus and celiac disease.Methodology. Two hundred and fifty six patients with Type 1 diabetes mellitus were screened (149 males and 107 females) during the study period of two years. Patients were evaluated for the clinical signs, biochemical investigations and family history of celiac disease in a tertiary care health centre in Western Uttar Pradesh, India.Results. Twenty four (9.3%) patients were diagnosed to have celiac disease; the mean age at diagnosis of diabetes was 9.3±7 years. Only one out of twenty four patients with celiac disease had been diagnosed before the detection of diabetes mellitus. Weight standard deviation score (SDS) increased from -0.12+1.3 at the start of gluten free diet to 0.8+0.9 after 12 months (p<0.004). Height SDS decreased from -2.46+1.1 at the start of gluten free diet to -2.14+0.9 after 12 months later (p=0.087). Bone age SDS increased from 9.2+6.3 at the start of gluten free diet to 10.3+6.7 after 12 months later. Height velocity increased from 4.7+0.7 cm/year in the year before treatment to 5.1+1.2 cm/year during treatment (p=0.05). The increase in Haemoglobin, serum calcium, and serum iron was statistically significant (p<0.05). Conclusion.Patients with celiac disease associated with type 1 diabetes mellitus frequently have poor glycemic control and impairment in several growth parameters. When these patients are put on a gluten restricted diet, they show signs of improvement in terms of weight gain, height, serum Ca, serum iron, haemoglobin, and in height velocity.

Does a Gluten-Free Diet Affect BMI and Glycosylated Hemoglobin in Children and Adolescents with Type 1 Diabetes and Asymptomatic Celiac Disease? A Meta-Analysis and Systematic Review

“…In the same cohort, patients with a dual diagnosis had significantly lower HDL cholesterol levels than individuals with T1DM alone at diagnosis; after the institution of a GFD, these levels increased significantly. The same effect was also noticed on bone density [ 51 ] as well as on hemoglobin and calcium levels [ 22 ]. A possible explanation for these improvements in cholesterol levels could be the normalization of the intestinal mucosa with the adoption of a GFD, demonstrating a beneficial effect of adhering to the diet.…”

“…As a secondary outcome, an improved lipid profile (HDL, total cholesterol, and triglyceride) after strict adherence to a GFD for at least six months was seen in three studies [ 18 , 19 , 20 ]. Hemoglobin and serum iron improved significantly after being on a GFD for at least six months [ 21 , 22 ]. Adherence to a GFD in patients with T1DM and CD might have a protective effect on the development of diabetic reno- and retinopathy [ 23 , 24 , 25 , 26 ], as seen in Table 2 .…”