Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up.
Study Goal
The researchers aimed to determine the benefits of screening for celiac autoimmunity in children with type 1 diabetes and evaluate the effects of a gluten-free diet on growth, bone density, and diabetes control.
Results Summary
TG+ children on a gluten-free diet showed better insulin-like growth factor binding protein 3 z-scores compared to those on a gluten-containing diet. Persistent high TG levels were associated with lower bone mineral density, ferritin, and vitamin D levels, but no significant adverse outcomes were noted in delaying gluten-free diet therapy for 2 years.
Population
Children with type 1 diabetes and screening-identified celiac autoimmunity (TG+).
Effective Dosage
Not specified
Duration
2 years
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibodies (TG) | no change | adverse outcomes | children with type 1 diabetes (T1D) with screening-identified TG+ who delay therapy with a gluten-free diet for 2 years | no significant change | no significant adverse outcomes were identified | #1 |
- | decrease | weight z-scores | TG+ subjects | - | had consistently lower | #2 |
- | increase | urine N-telopeptides | TG+ subjects | - | had consistently higher | #3 |
- | no change | bone density | TG+ subjects | - | had similar measures | #4 |
- | no change | diabetes outcomes | TG+ subjects | - | had similar measures | #5 |
gluten-containing diet | decrease | insulin-like growth factor binding protein 3 z-scores | TG+ children | - | had lower | #6 |
gluten-free diet | neutral | insulin-like growth factor binding protein 3 z-scores | TG+ subjects | - | compared with | #7 |
continued with high TG index throughout the study | decrease | bone mineral density z-scores | Children | - | had lower | #8 |
continued with high TG index throughout the study | decrease | ferritin | Children | - | had lower | #9 |
continued with high TG index throughout the study | decrease | vitamin D 25OH levels | Children | - | had lower | #10 |
OBJECTIVE: To determine the benefits of screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibodies (TG) in children with type 1 diabetes (T1D). STUDY DESIGN: We followed up 79 screening-identified TG+ and 56 matched TG- children with T1D for 2 years to evaluate growth, bone mineral density, nutritional status, and diabetes control. TG+ subjects self-selected to gluten-free or gluten-containing diet. RESULTS: Of the initial cohort, 80% were available for reexamination after 2 years. TG+ subjects had consistently lower weight z-scores and higher urine N-telopeptides than TG- subjects, but similar measures of bone density and diabetes outcomes. TG+ children who remained on a gluten-containing diet had lower insulin-like growth factor binding protein 3 z-scores compared with TG+ subjects who reported following a gluten-free diet. Children who continued with high TG index throughout the study had lower bone mineral density z-scores, ferritin, and vitamin D 25OH levels, compared with the TG- group. CONCLUSIONS: No significant adverse outcomes were identified in children with T1D with screening-identified TG+ who delay therapy with a gluten-free diet for 2 years. Children with persistently high levels of TG may be at greater risk. The optimal timing of screening and treatment for celiac disease in children with T1D requires further investigation.