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

Abstract

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.

Compliance to a Gluten-Free Diet in Swedish Children with Type 1 Diabetes and Celiac Disease

“…In our study worse glycemic control and the risk of experiencing DKAs was associated with poorer compliance. That better compliance is associated with a better glycemic control is in line with previous studies [28,29,32], and the only, to our knowledge, randomized controlled study (RCT) on the topic to date also found that a GFD resulted in better glycemic control [33]. In contrast with our results, the only other study on DKAs we found described no association between compliance and DKA [32].…”

“…In most studies, compliance was associated with better glycemic control [28,29] and/or growth [29,31]; only one found no association between compliance and growth [30]. We found one larger registry study on 608 double-diagnosed children which also reported good compliance to be associated with both better glycemic control and improved growth, but this study only found a good dietary adherence in 36% of the children [32]. Moreover a randomized controlled study comparing 15 double-diagnosed children on a GFD to 15 double-diagnosed children on a normal diet found children on a GFD to have better glycemic control after 12 months [33].…”

“…In contrast, two small studies with 9 and 20 children [30,31], conducted in 2008 and 1999, respectively, and one large register study with 608 children [32], conducted in 2019, found substantially lower compliance: between 30-44%. Reasons for these differences are unclear but could be explained by older data, different methods to establish compliance, and representativity of the analyzed samples.…”

Komorbiditäten bei Typ-1-Diabetes im Kindes- und Jugendalter

“…Nagl et al konnten in einer Arbeit mit Teilnehmenden aus der Gruppe der Diabetes-Patienten-Verlaufsdokumentation (DPV) zeigen, dass nur ein Drittel der Patienten mit T1D + Zöliakie konstant negative AK-Titer erreichte. Diejenigen mit konstant negativen AK-Nachweisen hatten eine bessere metabolische Kontrolle [11].…”

Type 1 Diabetes and Celiac Disease: Can (and Should) We Raise the Cut-off of Tissue Transglutaminase Immunoglobulin A to Decide Whether to Biopsy?

“…In the same vein, recent data from the first prospective randomized clinical trial in this regard concluded there could be a decrease in hypoglycemic episodes and better glycemic control in patients with T1DM with minimally symptomatic celiac disease following a GFD. 22,23 A recent interventional trial also suggests that there might be a beneficial effect of GFD in patients with T1DM, even if they do not have celiac disease. 24 Be that as it may, in my view the issue boils down to the following: There is solid evidence that celiac disease is quite common in children and adolescents with T1DM.…”