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The effect of biopsy‐positive silent coeliac disease and treatment with a gluten‐free diet on growth and glycaemic control in children with Type 1 diabetes
Author(s) -
Sun S.,
Puttha R.,
Ghezaiel S.,
Skae M.,
Cooper C.,
Amin R.
Publication year - 2009
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2009.02859.x
Subject(s) - coeliac disease , medicine , gastroenterology , asymptomatic , gluten free , odds ratio , diabetes mellitus , endocrinology , disease
Objective To determine the effect of coeliac disease and treatment with a gluten‐free diet on growth and glycaemic control in asymptomatic children with Type 1 diabetes. Methods Data were compared in children with coeliac disease diagnosed by annual antibody screening and jejunal biopsy and treated with a gluten‐free diet ( n = 49) against individuals who were antibody negative ( n = 49) matched for age, sex and duration of diabetes. Results No differences in growth were observed. In the years prior to diagnosis of coeliac disease, mean glycated haemoglobin (HbA 1c ) was lower in cases compared with control subjects [8.3 ± 1.1% vs. 8.7 ± 0.9%, P = 0.02 (mean ± sd )]. In cases, HbA 1c deteriorated 12 months from the start of a gluten‐free diet to levels similar to control subjects (8.9 ± 1.5% vs. 8.8 ± 1.5%, P ‐value for analysis of variance = 0.9). In regression analysis, the diagnosis of coeliac disease and start of a gluten‐free diet was associated with a rise in HbA 1c in the first year of treatment [odds ratio 1.56 (95% confidence intervals 1.16–2.10), P = 0.003] after adjusting for insulin dose and regimen and other variables. Conclusions In children with Type 1 diabetes, lower HbA 1c prior to diagnosis of silent coeliac disease rises following treatment with a gluten‐free diet to levels similar to those without coeliac disease. Although unproven, these observations may relate to abnormalities at the small bowel mucosa before the appearance of circulating coeliac antibodies.