Abstract
Background and Aims: A higher frequency of dyslipidemia is reported in children with type 1 diabetes (T1D) and celiac disease (CD). Recently, continuous subcutaneous insulin infusion (CSII) has been associated with better lipid profiles in patients with T1D. The aim of this study was to investigate the association between treatment modality and lipid profile, metabolic control, and body mass index (BMI)-SDS in children with both T1D and CD. Methods: Cross-sectional study in children registered in the international SWEET database in November 2020. Inclusion criteria were children (2–18 years) with T1D and CD with available data on treatment modality (CSII and injections therapy, IT), triglyceride, total cholesterol, HDL, LDL, dyslipidemia, HbA1c, and BMI-SDS. Overweight/obesity was defined as > +1 BMI-SDS for age. Data were analyzed by linear and logistical regression models with adjustment for age, gender, and diabetes duration. Results: In total 1009 children with T1D and CD (female 54%, CSII 54%, age 13.9 years ±3.6, diabetes duration 7.2 years ±4.1, HbA1c 7.9% ±1.4) were included. Significant differences between children treated with CSII vs. IT were respectively found; HDL 60.0 mg/dL vs. 57.8 mg/dL, LDL 89.4 mg/dL vs. 94.2 mg/dL, HbA1c 7.7 vs. 8.1%, BMI-SDS 0.4 vs. 0.6, overweight and obesity 17% vs. 26% (all p < 0.05). Conclusions: CSII is associated with higher HDL and lower LDL, HbA1c, BMI-SDS, and percentage of overweight and obesity compared with IT in this study. Further prospective studies are required to determine whether CSII improves lipid profile, metabolic control and normalize body weight in children with both T1D and CD.
Highlights
Celiac disease (CD) is a systemic immune-mediated disorder caused by the ingestion of gluten-containing grains in genetically susceptible persons [1]
Results from Adjusted Regression Models. This difference between continuous subcutaneous insulin infusion (CSII) and IT group was confirmed by linear regression analysis, adjusted for age, gender, and diabetes duration
Our study shows that the use of CSII is associated with improved glycemic control, body mass index (BMI)-SDS and lipid profile as compared with IT in a large cohort of children and adolescents with both celiac disease (CD) and type 1 diabetes (T1D)
Summary
Celiac disease (CD) is a systemic immune-mediated disorder caused by the ingestion of gluten-containing grains in genetically susceptible persons [1]. While CD prevalence approaches 1% in the general population, [2] it ranges between 1.6% and 9.7% in patients with type 1 diabetes (T1D) worldwide [3], there are a significant number of individuals with both CD and T1D. Individuals with T1D have a higher risk to develop cardiovascular disease compared with the general population [5]. In children with early atherosclerotic signs, dyslipidemia has been found to be present since childhood [6,7]. It is well-known, that higher level of triglyceride and LDL predict cardiovascular disease [8]. Recent epidemiological studies described increased mortality and higher microvascular complication in individuals with T1D and concomitant CD, suggesting that these patients represent a distinct risk group [9,10]
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