Issue 117 Item 6 Gluten-Free Diet in Diabetic Children With Celiac Disease Impro

Early diagnosis of silent celiac disease in children with type 1 diabetes and institution of a gluten-free diet improves metabolic control and growth. Dr. David B. Dunger, of Addenbrooke’s Hospital in Cambridge, and associates conducted a longitudinal study of growth and metabolic control in 11 children with type 1 diabetes who were subsequently diagnosed with celiac disease. Findings were compared with those of 22 age- and sex-matched children with diabetes but no celiac disease.

The CD+ children, representing 4.8% of diabetic children treated at a pediatric diabetic clinic between 1994 and 1998, were diagnosed on the basis of anti-gliadin and anti-endomysial antibodies and confirmatory biopsy. Only one had typical symptoms of CD, and four had mild symptoms recognized in retrospect.

At the time of diabetes diagnosis, the CD+ children had a significantly lower mean BMI standard deviation score (SDS) than control subjects, -1.2 versus -0.1 (p=0.005). Mean height SDS and C-peptide level were similar between the two groups. Mean HbA-1-c was significantly better in the CD+ group at 8.9% compared with 9.8% in the CD- group.

After 12 months on a gluten-free diet, the CD+ group caught up with the CD- group in terms of mean BMI SDS score. HbA-1-c further improved to 8.3% in the CD+ group during this time period, while for the control subjects it increased to 10.0%.

In the second study, Dr. Anette-G. Ziegler, of the Academic Teaching Hospital M nchen-Schwabing in Munich, and associates followed seven first-degree relatives, ages 6 and below, of patients with type 1 diabetes.

Titers of type 1 diabetes-associated autoantibodies failed to improve while the subjects were on a gluten-free diet for 12 months, whereas IgG antibody titers to gliadin were reduced.

Dr. Ziegler and her colleagues conclude that "gluten does not drive production of islet autoantibodies in type 1 diabetes as it does in celiac disease."

Diabetes Care 2002;25:1111-1122.