Abstract
The gluten free diet (GFD) has a high glycemic index and low-fiber content, which potentially influences glycemic excursions in type 1 diabetes (T1D) and celiac disease (CD). Participants in this case-control study of youth with T1D+CD (n = 10) and T1D only (n = 7) wore blinded continuous glucose monitoring systems for six days. Blood glucose levels (BGLs) were compared between groups for each meal, including pre-meal, peak, 2-hour postprandial and time-to-peak. Participants consumed a test-breakfast of GF cereal and milk for three days and kept weighed food diaries; nutrient intake was analyzed and compared to national recommendations. Youth with T1D+CD had shorter time-to-peak BGL (77 vs 89 mins, P = 0.03), higher peak (9.3 vs 7.3 mmol/L, P = 0.001) and higher postprandial BGLs than T1D (8.4 vs 7.0 mmol/L, P = 0.01), despite similar pre-meal BGLs (9.2 vs 8.6 mmol/L, P = 0.28). Regarding test breakfast, greater pre and post-meal BGL difference correlated with longer CD duration (R = 0.53, P = 0.01). Total energy and macronutrient intake didn’t differ between groups; however the majority of participants collectively had inadequate intake of calcium (76%), folate (71%) and fiber (53%), with excessive saturated fat (12%) and sodium (>2,000 mg/day). The GFD is associated with greater glycemic excursions and inadequate nutritional intake in youth with T1D+CD. Clinical management should address both glycemic variability and dietary quality.
Highlights
Post-prandial excursions (PPE) and (ii) macronutrient, micronutrient and fiber intake in youth with type 1 diabetes (T1D)+celiac disease (CD) compared to those T1D alone
All but one of the T1D+CD patients was gluten free diet (GFD) adherent, and as results were not significantly different when this patient was excluded, their data were included in the analyses
In the diabetes alone group, diabetes duration was not associated with change in pre- to peak blood glucose levels (BGLs) values (P = 0.50). This is the first study to examine the impact of the GFD in youth with coexisting CD and T1D on glycemic variability and nutrient intake
Summary
Post-prandial excursions (PPE) and (ii) macronutrient, micronutrient and fiber intake in youth with T1D+CD compared to those T1D alone. The study protocol included youth wearing a blinded continuous glucose monitoring system (CGMS), consumption of the same test breakfast for three days, completion of a weighed food diary and documentation of diabetes care (injections or pumps, daily insulin doses and all BGLs measured using a glucometer). All participants attended their diabetes review appointment with their pediatric endocrinologist in the six weeks prior to the study visit for adjustment of insulin doses, or insulin pump settings. Glycemic targets were set as 4.0–7.8 mmol/l, with hypoglycemia defined as a blood glucose level (BGL) ≤ 3.9 mmol/mol, euglycemia between 4.0–7.8 mmol/mol, and hyperglycemia as ≥7.9 mmol/mol
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