ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes

Mahmud, Farid H; Elbarbary, Nancy Samir; Fröhlich‐Reiterer, Elke; Holl, Reinhard W.; Kordonouri, Olga; Knip, Mikael; Simmons, Kimber M.; Craig, Maria E.

doi:10.1111/pedi.12740

Cited by 107 publications

(140 citation statements)

References 184 publications

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“…The role of the GFD in T1D‐related outcomes is, at present, still unclear . It is understood that those with T1D with undiagnosed CD may be at increased risk of nephropathy and retinopathy and that adherence to the GFD can ameliorate symptoms and nutritional status .…”

Section: Discussionmentioning

confidence: 99%

Online education for gluten‐free diet teaching: Development and usability testing of an e‐learning module for children with concurrent celiac disease and type 1 diabetes

et al. 2019

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Background and Objective Celiac disease (CD), the most common genetically‐based food intolerance, affects 3% to 16% of children with type 1 diabetes (T1D). Treatment involves lifelong adherence to a gluten‐free diet (GFD). Individualized dietary education is resource‐intensive. We, therefore, sought to develop and test the usability of an e‐learning module aimed at educating patients and caregivers regarding implementation of the GFD in children with concurrent CD and T1D. Methods An interactive e‐learning module was developed based on extensive review of CD, T1D, and educational literature. A mixed‐methods usability testing approach was used to refine and evaluate the module, using qualitative semi‐structured interviews, observations, and satisfaction and knowledge questionnaires in two iterative cycles. The module was refined based on themes identified from each usability cycle. Results Eighteen patients (8 in cycle 1, 10 in cycle 2) and 15 caregivers (7 in cycle 1, 8 in cycle 2) participated. Patient participants had CD and T1D for a mean (SD) of 6.1 ± 5.1 and 8.3 ± 5.5 years, respectively. Their mean age was 13.5 ± 4.5 years. Thematic analysis of usability interviews showed the module to be appealing and resulted in minor module revisions after each cycle to improve usability. Mean satisfaction scores post‐module completion were high (4.67 ± 0.54), indicating participants were “very satisfied” with the education. Knowledge test scores increased significantly from pre‐ to post‐module completion (P = 0.001). Conclusion A multifaceted user‐centered usability approach demonstrated that an innovative, interactive e‐learning module is effective in knowledge retention and can provide comprehensive and accessible information in the implementation of the GFD teaching in children with CD and T1D.

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Section: Discussionmentioning

confidence: 99%

Online education for gluten‐free diet teaching: Development and usability testing of an e‐learning module for children with concurrent celiac disease and type 1 diabetes

et al. 2019

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“…We do not know how strictly GFD was recommended by the various treatment centers and how much supportive diet counseling was provided to patients and families. Nonetheless, all centers, participating in the DPV initiative comply with internationally valid treatment guidelines …”

Section: Discussionmentioning

confidence: 99%

“…Celiac disease (CD) is an immune‐mediated systemic autoimmune disease in genetically susceptible persons (HLA DQ2 and/or HLA DQ8) triggered by gluten and related prolamins characterized by a wide variety of gluten dependent symptoms and an enteropathy with a specific histopathology of the small gut mucosa. Due to HLA relation CD is a frequent co‐morbidity in type 1 diabetes (T1D) with a wide range of prevalence of up to 10% worldwide compared to 1% in the general population. Based on registry data from the multicenter, standardized DPV (Diabetes Patienten Verlaufsdokumentation) database, biopsy‐confirmed CD was documented in 3.2% of pediatric T1D‐patients …”

Section: Introductionmentioning

confidence: 99%

“…CD may manifest with gastrointestinal symptoms due to malabsorption, and growth retardation, however the majority of patients, including those with T1D, have no or non‐specific symptoms. Therefore, the ISPAD Clinical Practice Consensus Guidelines recommend a regular screening for CD at T1D onset and every 1‐2 years thereafter . Irrespective of symptoms, T1D patients with CD show significant differences in height and weight percentiles compared to patients with T1D alone even years after diagnosis …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the ISPAD Clinical Practice Consensus Guidelines recommend a regular screening for CD at T1D onset and every 1‐2 years thereafter . Irrespective of symptoms, T1D patients with CD show significant differences in height and weight percentiles compared to patients with T1D alone even years after diagnosis …”

Section: Introductionmentioning

confidence: 99%

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Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

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Objectives To study celiac‐specific antibody status over 3 years in patients with type 1 diabetes and biopsy‐proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody‐negativity (Ab‐neg) and staying antibody‐positive (Ab‐pos). Methods A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody‐status. Differences between Ab‐neg (n = 218) and Ab‐pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background. Results Thirty‐six percent of T1D + CD patients reached and sustained antibody‐negativity 3 years after CD diagnosis. The median time until patients returned to Ab‐neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab‐neg and highest in Ab‐pos patients compared to T1D‐only patients (adjusted mean (95%CI): 7.72 (7.51‐7.92) % vs 8.44 (8.20‐8.68) % vs 8.19 (8.17‐8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL‐cholesterol and frequency of dyslipidemia were significantly lower in Ab‐neg compared to T1D‐only patients (167 (161‐173) mg/dl vs 179 (178‐179) mg/dl, P < .001; 90 (84‐96) mg/dl vs 99 (98‐99) mg/dl, P = .005; 15.7 (10.5‐22.9) % vs 25.9 (25.2‐26.6) %, P = .017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c (P < .001) and a lower height‐SDS (P = .044) was observed in Ab‐pos compared to Ab‐neg patients. Conclusion Only one third of T1D + CD patients reached constant Ab‐negativity after CD diagnosis. Achieving Ab‐negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.

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Diabetes Mellitus

Ambler¹,

Cameron²,

Joshi³

et al. 2019

Brook's Clinical Pediatric Endocrinology

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ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes

Cited by 107 publications

References 184 publications

Online education for gluten‐free diet teaching: Development and usability testing of an e‐learning module for children with concurrent celiac disease and type 1 diabetes

Online education for gluten‐free diet teaching: Development and usability testing of an e‐learning module for children with concurrent celiac disease and type 1 diabetes

Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis

Diabetes Mellitus

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