Nutritional status, growth and disease management in children with single and dual diagnosis of type 1 diabetes mellitus and coeliac disease

Abstract

BackgroundThe consequences of subclinical coeliac disease (CD) in Type 1 diabetes mellitus (T1DM) remain unclear. We looked at growth, anthropometry and disease management in children with dual diagnosis (T1DM + CD) before and after CD diagnosis.MethodsAnthropometry, glycated haemoglobin (HbA1c) and IgA tissue transglutaminase (tTg) were collected prior to, and following CD diagnosis in 23 children with T1DM + CD. This group was matched for demographics, T1DM duration, age at CD diagnosis and at T1DM onset with 23 CD and 44 T1DM controls.ResultsNo differences in growth or anthropometry were found between children with T1DM + CD and controls at any time point. Children with T1DM + CD, had higher BMI z-score two years prior to, than at CD diagnosis (p < 0.001). BMI z-score change one year prior to CD diagnosis was lower in the T1DM + CD than the T1DM group (p = 0.009). At two years, height velocity and change in BMI z-scores were similar in all groups. No differences were observed in HbA1c between the T1DM + CD and T1DM groups before or after CD diagnosis. More children with T1DM + CD had raised tTg levels one year after CD diagnosis than CD controls (CDx to CDx + 1 yr; T1DM + CD: 100% to 71%, p = 0.180 and CD: 100% to 45%, p < 0.001); by two years there was no difference.ConclusionsNo major nutrition or growth deficits were observed in children with T1DM + CD. CD diagnosis does not impact on T1DM glycaemic control. CD specific serology was comparable to children with single CD, but those with dual diagnosis may need more time to adjust to gluten free diet.

Type 1 Diabetes in Children and Adolescents

“…There is good evidence that treatment of classic or atypical celiac disease with a gluten-free diet improves intestinal and extraintestinal symptoms (147), and prevents the long-term sequelae of untreated classic celiac disease (148). However, there is no evidence that untreated asymptomatic celiac disease is associated with short-or long-term health risks (149,150) or that a gluten-free diet improves health in these individuals (151). Thus, universal screening for and treatment of asymptomatic celiac disease remains controversial (Table 4).…”

Endocrine manifestations in celiac disease

“…Time course studies of diagnosis of type 1 diabetes and CD suggests that diagnosis of type 1 diabetes usually occurs first, followed by CD[ 63 - 66 ]. In patients with type 1 diabetes and celiac disease, additional autoimmune diseases may later develop, particularly autoimmune thyroid disease[ 67 - 69 ]. Moreover, risk of disease complications, including bone disease, retinopathy or nephropathy may occur, particularly if concomitant CD is present[ 67 - 71 ], and symptoms associated with CD may be more difficult to resolve if type 1 diabetes is also present[ 69 ].…”

Growth of children with type 1 diabetes mellitus

“…podwójną diagnozą mogą wymagać dłuższego czasu na osiągnięcie poprawy w zakresie dodatkowej choroby przewlekłej (np. potrzeba dłuższego czasu na dostosowanie się do diety bezglutenowej), a trudności w uzyskaniu wyrównania metabolicznego mogą wynikać właśnie z tych powodów i wpływać na przebieg wzrastania [38].…”