Abstract
AimGluten-free diet has shown promising effects in preventing type 1 diabetes (T1D) in animals as well as beneficial effects on the immune system. Gluten-free diet at diabetes onset may alter the natural course and outcome of autoimmune diseases such as T1D.MethodsIn a 12-month study, 15 children newly diagnosed with T1D were instructed to follow a gluten-free diet. Questionnaires were used to evaluate adherence to the gluten-free diet. Partial remission (PR) was defined by insulin dose-adjusted A1c (IDAA1c) ≤9 or stimulated C-peptide (SCP) >300 pmol/L measured 90 min after a liquid mixed meal at the inclusion, six and 12 months after onset. The intervention group was compared with two previous cohorts. Linear mixed models were used to estimate differences between cohorts.ResultsAfter 6 months, more children on a gluten-free diet tended to have SCP values above 300 pmol/L compared to the European cohort (p = 0.08). The adherence to a gluten-free diet decreased during the 12-month study period. After 1 year there was no difference in SCP levels or percentage in remission according to SCP (p > 0.1). Three times as many children were still in PR based on IDAA1c (p < 0.05). Twelve months after onset HbA1c were 21 % lower and IDAA1c >1 unit lower in the cohort on a gluten-free diet compared to the two previous cohorts (p < 0.001).ConclusionGluten-free diet is feasible in highly motivated families and is associated with a significantly better outcome as assessed by HbA1c and IDAA1c. This finding needs confirmation in a randomized trial including screening for quality of life. (Clinicaltrials.gov number NCT02284815).
Highlights
Maintained endogenous insulin production in patients with type 1 diabetes (T1D) is associated with better metabolic control and a lower prevalence of adverse events, including hypoglycemia, ketoacidosis and micro-vascular complication (Sjöberg et al 1987; Steffes et al 2003; Madsbad et al 1986; Lachin et al 2014; Madsbad et al 1979)
Patients diagnosed in the study period meeting inclusion criteria were invited to participate, only those expressing interest were approached for further information
The gender, mean age at onset, BMI z-score, and the corresponding diabetes duration of the three cohorts are presented in Table 2, showing a significantly longer diabetes duration, higher stimulated C-peptide (SCP) level and lower BMI at entry into the study in the gluten-free diet cohort
Summary
Maintained endogenous insulin production in patients with type 1 diabetes (T1D) is associated with better metabolic control and a lower prevalence of adverse events, including hypoglycemia, ketoacidosis and micro-vascular complication (Sjöberg et al 1987; Steffes et al 2003; Madsbad et al 1986; Lachin et al 2014; Madsbad et al 1979). C-peptide is used as a measure of endogenous insulin production and is tested either fasting or after After their diagnoses, most patients with T1D experience an increase in endogenous insulin release, which peaks approximately 3 months after onset. Most patients with T1D experience an increase in endogenous insulin release, which peaks approximately 3 months after onset This is partly caused by beta-cell rest and by a reduction in the immune inflammatory conditions in the islets (Schloot et al 2007; Aly and Gottlieb 2009). An alternative intervention is a gluten-free diet This is motivated by animal studies where gluten has been shown to affect gut permeability, proinflammation, beta cells, natural killer (NK) cells and gut microbiota (Drago et al 2006; Ejsing-Duun et al 2008; Antvorskov et al 2013; Dall et al 2013; Marietta et al 2013; Larsen et al 2014)
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