Endocrine Abstracts

Background: Coeliac disease (CD) is common in children with type 1 diabetes mellitus, so that CD screening of all asymptomatic diabetic children is carried out in many medical centres. While introduction of a gluten-free diet (GFD) might improve glycaemic control, the burden of two dietary regimes could adversely affect compliance.

Aim: To assess the short-term effect of the diagnosis and treatment of asymptomatic CD detected by screening on diabetic control and anthropometric measurements 1 year before and 1 year after the diagnosis of CD and introduction of GFD in children with type 1 diabetes at a single paediatric centre.

Design: Retrospective longitudinal case–control study of 21 diabetic children with CD and 21 diabetic controls matched for age, sex, and duration of diabetes.

Results: In 21 pairs (24 girls, 18 boys), the age at diagnosis of diabetes mellitus in coeliac group and controls was 5.6±3.3 and 5.8±3.2 years, respectively (P=0.8). The coeliac cases were diagnosed with CD at 11.1±2.45 years of age. HbA1c levels (%) were 8.49±1.35, 8.35±1.17, and 8.45±0.99 in controls, coeliac cases pre-GFD, and post-GFD, respectively. HbA1c, insulin requirements, height SDS, weight SDS, BMI SDS did not change in coeliac cases 1 year before and after of introduction of GFD. All of these values during pre-GFD and after-GFD periods were similar to those of controls with exception of insulin requirement, which was significantly higher after diagnosis of CD than in controls (1.28±0.36 vs 1.09±0.38 unit/kg per day, P=0.001). Individual analysis of all values at each time point between cases and controls did not reach statistical significance over the 2-year period.

Conclusion: We have found no evidence that diagnosis of CD and introduction of GFD in diabetic children affects glycaemic control or growth. However, it may be associated with a slight increase in daily insulin requirements.