Clinical Benefit of a Gluten-Free Diet in Type 1 Diabetic Children With Screening-Detected Celiac Disease

A population-based screening study with 2 years’ follow-up

  1. Dorte Hansen, MD, PHD1,
  2. Bendt Brock-Jacobsen, MD, DMS1,
  3. Elisabeth Lund, MD2,
  4. Christina Bjørn, MD3,
  5. Lars P. Hansen, MD4,
  6. Christian Nielsen, CS5,
  7. Claus Fenger, MD, DMS6,
  8. Søren T. Lillevang, MD, PHD5 and
  9. Steffen Husby, MD, DMS1
  1. 1Department of Pediatrics, Odense University Hospital, Odense, Denmark
  2. 2Department of Pediatrics, Kolding Hospital, Kolding, Denmark
  3. 3Deparment of Pediatrics, Esbjerg Hospital, Esbjerg, Denmark
  4. 4Department of Pediatrics, Sonderborg Hospital, Sonderborg, Denmark
  5. 5Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
  6. 6Department of Pathology, Odense University Hospital, Odense, Denmark
  1. Address correspondence and reprint requests to Dorte Hansen, Department of Pediatrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. E-mail: dorte.hansen{at}dadlnet.dk

Abstract

OBJECTIVE—This study was performed to 1) determine the prevalence of celiac disease in Danish children with type 1 diabetes and 2) estimate the clinical effects of a gluten-free diet (GFD) in patients with diabetes and celiac disease.

RESEARCH DESIGN AND METHODS—In a region comprising 24% of the Danish population, all patients <16 years old with type 1 diabetes were identified and 269 (89%) were included in the study. The diagnosis of celiac disease was suspected in patients with endomysium and tissue transglutaminase antibodies in serum and confirmed by intestinal biopsy. Patients with celiac disease were followed for 2 years while consuming a GFD.

RESULTS—In 28 of 33 patients with celiac antibodies, an intestinal biopsy showed villous atrophy. In 5 patients, celiac disease had been diagnosed previously, giving an overall prevalence of 12.3% (95% CI 8.6–16.9). Patients with celiac disease had a lower SD score (SDS) for height (P < 0.001) and weight (P = 0.002) than patients without celiac disease and were significantly younger at diabetes onset (P = 0.041). A GFD was obtained in 31 of 33 patients. After 2 years of follow-up, there was an increase in weight SDS (P = 0.006) and in children <14 years old an increase in height SDS (P = 0.036). An increase in hemoglobin (P = 0.002) and serum ferritin (P = 0.020) was found, whereas HbA1c remained unchanged (P = 0.311) during follow-up.

CONCLUSIONS—This population-based study showed the highest reported prevalence of celiac disease in type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a GFD. We recommend screening for celiac disease in all children with type 1 diabetes.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted July 25, 2006.
    • Received May 14, 2006.
| Table of Contents