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Diabetic Medicine
Year: 2009  |  Volume: 26  |  Issue: 12  |  Page No.: 1250 - 1254

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

S. Sun, R. Puttha, S. Ghezaiel, M. Skae, C. Cooper and R. Amin    

Abstract: 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 (HbA1c) was lower in cases compared with control subjects [8.3 ± 1.1% vs. 8.7 ± 0.9%, P = 0.02 (mean ± sd)]. In cases, HbA1c 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 HbA1c 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 HbA1c 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.

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