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Lower HbA1c in patients with type 1 diabetes and celiac disease who reached celiac‐specific antibody‐negativity—A multicenter DPV analysis
Author(s) -
Nagl Katrin,
Bollow Esther,
Liptay Susanne,
Rosenbauer Joachim,
Koletzko Sibylle,
Pappa Angeliki,
Näke Andrea,
FröhlichReiterer Elke,
Döring Christian,
Wolf Johannes,
Salfeld Peter,
Prinz Nicole
Publication year - 2019
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12908
Subject(s) - medicine , gastroenterology , type 1 diabetes , diabetes mellitus , dyslipidemia , antibody , disease , endocrinology , immunology
Objectives To study celiac‐specific antibody status over 3 years in patients with type 1 diabetes and biopsy‐proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody‐negativity (Ab‐neg) and staying antibody‐positive (Ab‐pos). Methods A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody‐status. Differences between Ab‐neg (n = 218) and Ab‐pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background. Results Thirty‐six percent of T1D + CD patients reached and sustained antibody‐negativity 3 years after CD diagnosis. The median time until patients returned to Ab‐neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab‐neg and highest in Ab‐pos patients compared to T1D‐only patients (adjusted mean (95%CI): 7.72 (7.51‐7.92) % vs 8.44 (8.20‐8.68) % vs 8.19 (8.17‐8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL‐cholesterol and frequency of dyslipidemia were significantly lower in Ab‐neg compared to T1D‐only patients (167 (161‐173) mg/dl vs 179 (178‐179) mg/dl, P < .001; 90 (84‐96) mg/dl vs 99 (98‐99) mg/dl, P = .005; 15.7 (10.5‐22.9) % vs 25.9 (25.2‐26.6) %, P = .017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c ( P < .001) and a lower height‐SDS ( P = .044) was observed in Ab‐pos compared to Ab‐neg patients. Conclusion Only one third of T1D + CD patients reached constant Ab‐negativity after CD diagnosis. Achieving Ab‐negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.