Compliance to a Gluten-Free Diet in Swedish Children with Type 1 Diabetes and Celiac Disease.

Hanna Söderström,Matti Cervin,Cathrine Ahlstermark,Julia Rehn,Annelie Carlsson,Mara Cerqueiro Bybrant

doi:10.3390/nu13124444

Hanna Söderström, Matti Cervin + Show 4 more

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https://doi.org/10.3390/nu13124444

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Abstract

Children with type 1 diabetes (T1D) are at increased risk of celiac disease (CD). The replacement of insulin in T1D, and the exclusion of gluten in CD, are lifelong, burdensome treatments. Compliance to a gluten-free diet (GFD) in children with CD is reported to be high, while compliance in children with both diseases has scarcely been studied. To examine compliance to a GFD in children with both T1D and CD, we analyzed tissue transglutaminase IgA-antibodies (tTGA). Moreover, associations between compliance and age, sex, glycemic control, ketoacidosis (DKA), body mass index (BMI), and time of CD diagnosis were investigated. Of the 743 children diagnosed with T1D in southern Sweden between 2005 and 2012, 9% were also diagnosed with CD. Of these, 68% showed good compliance to a GFD, 18% showed intermediate compliance, and 14% were classified as non-compliant. Higher age, poorer HbA1c, and more DKAs were significantly (p < 0.05) associated with poorer compliance. In conclusion, we found that compliance to a GFD in children with T1D and CD is likely be lower than in children with CD only. Our results indicate that children with both T1D and CD could need intensified dietary support and that older children and children with poor metabolic control are especially vulnerable subgroups.

Highlights

Accepted: 9 December 2021Children with type 1 diabetes (T1D) have an increased risk of being diagnosed with celiac disease (CD) compared to the general population [1]
The diagnostic criteria used for T1D patients in Sweden subscribe to the diabetes classification of the American Diabetes Association [34], whereas all included children with a CD diagnosis were diagnosed by confirmed small intestinal biopsy
We found no difference in compliance between those that received a CD diagnosis prior to T1D compared to those who received their CD diagnosis at or after T1D diagnosis (p = 0.91)

Summary

Introduction

Children with type 1 diabetes (T1D) have an increased risk of being diagnosed with celiac disease (CD) compared to the general population [1]. T1D and CD are chronic diseases that share genetic risk factors such as HLA DQ2 and DQ8 [6]. The incidence of both diseases has increased during the last few decades [7,8,9], pointing towards possible environmental risk factors [10]. GFD foods often have a high glycemic index [13,14] and, children with CD have a higher dietary glycemic index in their diet [15,16]

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