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Clinical Care/Education/Nutrition

Elimination of Dietary Gluten Does Not Reduce Titers of Type 1 Diabetes-Associated Autoantibodies in High-Risk Subjects

  1. Michael Hummel, MD1,
  2. Ezio Bonifacio, PHD2,
  3. Heike E. Naserke, PHD1 and
  4. Anette G. Ziegler, MD1
  1. 1Diabetes Research Institute and 3rd Medical Department, Academic Teaching Hospital München-Schwabing, Munich, Germany
  2. 2Instituto Scientifico San Raffaele, Milan, Italy
    Diabetes Care 2002 Jul; 25(7): 1111-1116. https://doi.org/10.2337/diacare.25.7.1111
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      Figure 1—

      Course of islet autoantibodies in subjects undergoing gluten-free diet. Autoantibodies to insulin (x), GAD (○) and IA-2 (⧫) were measured by radiobinding assays. The thresholds for positivity were 2, 10, and 5 units, respectively. The period under gluten-free diet is shaded. IgG-gliadin antibodies were measured by enzyme-linked immunosorbent assay with a commercial kit. ++, OD >0.2; +, OD 0.087–0.2; -, OD < 0.087. Type 1 diabetes developed in two subjects (cases 1 and 2) during the gluten reexposure period.

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      Figure 2—

      Levels of each antibody subclass of IAA (A), GADA (B), and IA-2A (C) in the seven treated high-risk relatives before (a) and after (b) the 12-month gluten-free diet period and 12 months after reexposure to gluten (c). The dotted lines represents the threshold for positivity. IAA subclasses are expressed in nU/ml serum; GADA and IA-2A subclasses are shown in standard deviation scores.

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      Figure 3—

      Risk of progression to diabetes by Kaplan-Meier analysis in seven children under intervention compared with historical control siblings and offspring (P = 0.8). All children in the intervention and historical control group were aged <6 years and had multiple islet autoantibodies and a normal result of OGTT at the start of the study.

    Tables

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    • Table 1—

      Characteristics of the seven first-degree relatives at risk at the beginning of the gluten-free diet

      CaseProbandAge (years)HLA-DRB1HLA-DQB1IAA (units)GADA (units)IA-2A (units)OGTT 2 h pp (mg/dl)
      1Mother1.201, 04Not tested9.715179470
      2Mother5.403, 1302, 060312.32591125
      3Father5.901, 04050501, 0211.28565681
      4Mother2.403, 040102, 03025.180089
      5Both parents4.30401, 04080304, 030224.810516374
      6Sister4.003, 040202, 030214.810946996
      7Father2.001, 04010302, 050117.714083
      • Data are n. Thresholds for IAA 1.5 units, GADA 8.5 units, IA-2A 2.5 units.

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    Diabetes Care: 25 (7)

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    July 2002, 25(7)
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    Elimination of Dietary Gluten Does Not Reduce Titers of Type 1 Diabetes-Associated Autoantibodies in High-Risk Subjects
    Michael Hummel, Ezio Bonifacio, Heike E. Naserke, Anette G. Ziegler
    Diabetes Care Jul 2002, 25 (7) 1111-1116; DOI: 10.2337/diacare.25.7.1111

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    Elimination of Dietary Gluten Does Not Reduce Titers of Type 1 Diabetes-Associated Autoantibodies in High-Risk Subjects
    Michael Hummel, Ezio Bonifacio, Heike E. Naserke, Anette G. Ziegler
    Diabetes Care Jul 2002, 25 (7) 1111-1116; DOI: 10.2337/diacare.25.7.1111
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