Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control

Abstract

Type 1 diabetes mellitus is associated with celiac disease, with a prevalence that varies between 0.6% and 16.4%, according to different studies. After a diagnosis of celiac disease is confirmed by small bowel biopsy, patients are advised to commence a gluten-free diet (GFD). This dietary restriction may be particularly difficult for the child with diabetes, but in Europe (and in Italy) many food stores have targeted this section of the market with better labeling of products and more availability of specific GFD products. Treatment with a GFD in symptomatic patients has been shown to improve the symptoms, signs and complications of celiac disease. However, the effects of a GFD on diabetic control are less well established. Initial reports of improved hypoglycemic control were based on children who were diagnosed with celiac disease associated with malabsorption, but there have subsequently been reports of improvement in patients with type 1 diabetes with subclinical celiac disease. There are other studies reporting no effect, improved control and an improvement of hypoglycemic episodes. Moreover, in this review we wish to focus on low glycemic index foods, often suggested in people with type 1 diabetes, since they might reduce postprandial glycemic excursion and enhance longterm glycemic control. In contrast, GFD may be rich in high glycemic index foods that can increase the risk of obesity, insulin resistance and cardiovascular disease, worsening the metabolic control of the child with diabetes. Hence, it is important to evaluate the impact of a GFD on metabolic control, growth and nutritional status in children with type 1 diabetes.

Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes

“…We have not observed any difference in the diabetes associated Ab profile for children with optimal or poor glycemic control. This is in agreement with previous studies that found no correlation between single and/or combined diabetes Ab positivity and diabetes control where some pancreatic function was preserved [39,40,46]. However, interestingly it was proved recently, that autoimmune thyroiditis accompanying T1DM is associated with worse glycemic control and lipid profile [47].…”

“…The association of T1DM and AITD is highly dependent on age, sex and ethnicity [36]. Approximately 10% of T1DM patients are affected by CD with prevalence ranging from 0.6% to 16.4% reported in different studies [10,[37][38][39] and that is significantly higher than in non-diabetic children (1%-2% of the population). CD and T1DM may develop in parallel however usually T1DM precedes the onset of CD [40].…”

A nationwide population-based study on the risk of coma, ketoacidosis and hypoglycemia in patients with celiac disease and type 1 diabetes

“…Pertaining to metabolic control, many gluten-free foods used in the management of CD have a high glycemic index [9]. This could potentially influence glycemic control and the development of acute metabolic complications (diabetic ketoacidosis and hypoglycemia).…”

Studies of Mucosal Immune Regulation in Celiac Disease and Type 1 Diabetes

“…About 4-9 % of patients with T1D develop CD [323,324]. Children with T1D undergo screening for CD since less than 10% of patients with T1D who develop CD show gastrointestinal symptoms, thus most of the children are either asymptomatic or only mildly symptomatic [325].…”