Purpose Children with type 1 diabetes mellitus (T1DM) have an increased risk for celiac disease (CD), despite absence of clinical symptoms of CD. Benefits of screening and early treatment of CD are unknown. Our objective is to evaluate the impact of early treatment of CD on the growth, intestinal permeability, diabetes control, and bone density of subjects with diabetes and celiac autoimmunity (tissue tranglutaminase antibody (TG) positivity).
Methods This is a prospective, observational study of children with T1DM characterized as TG+ or TG- through screening. TG+ subjects self-select to gluten-free diet (GFD) or regular diet (RD). Primary outcomes are diabetes control, intestinal permeability, growth, and bone density. Data are mean ± SD.
Results To date, 42 TG+ subjects have completed the baseline visit (22 GFD, 20 RD), 30 have completed the 6 month visit (17 GFD, 13 RD), and 21 have completed the 12 month visit (10 GFD, 11 RD). At baseline there are no significant differences between the TG+ groups (mean age for GFD group was 10.2 ± 3.3 years, and RD group was 11.4 ± 3.4; duration of diabetes was 5.4 ± 3.9 years for GFD group and 7.2 ± 3.4 for RD group; mean duration of GFD was 10.4 ± 1.0 months; TG index was 0.63 ± .56 in GFD group and 0.4 ± 0.38 in RD group; HbA1C was 8.15% ± 1.2 for GFD group and 8.9% ±1.5 for RD group; and the height z-score was -0.24 ± 1.18 for GFD group, and 0.07 ± 1.1 for RD group). There were also no significant differences between the TG+ groups at 6 or 12 months for any variables including race, gender, ethnicity, age, diabetes duration, TG index, HbA1C, urine microalbumin, and z-scores for body mass index, height-for-age, and weight-for-age. Additionally, there were no differences for lumbar or volumetric spine z-scores for chronological or bone age, nor differences in intestinal permeability as measured by sucrose breath test between groups at baseline or 12 months. Report of symptoms also did not differ at baseline or 12 months, but an increase in flatulence was reported in the RD group at 6 months.
Conclusions There were no significant differences between the TG+ groups at baseline, 6 months, or 12 months. Therefore, there is no evidence of benefit of GFD at one year. Further enrollment and follow-up is needed to determine whether there are benefits to screening for CD in children with T1DM and whether early initiation of GFD is necessary in patients with CD.
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