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Screening and Treatment Outcomes in Adults and Children with Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

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posted on 2020-04-28, 21:57 authored by Farid H. Mahmud, Antoine B.M. Clarke, Kariym C. Joachim, Esther Assor, Charlotte McDonald, Fred Saibil, Heather A. Lochnan, Zubin Punthakee, Amish Parikh, Andrew Advani, Baiju R. Shah, Bruce A. Perkins, Caroline S. Zuijdwijk, David R. Mack, Dror Koltin, Emilia N. De Melo, Eugene Hsieh, Geetha Mukerji, Jeremy Gilbert, Kevin Bax, Margaret L. Lawson, Maria Cino, Melanie D. Beaton, Navaaz A. Saloojee, Olivia Lou, Patricia H. Gallego, Permysl Bercik, Robyn L. Houlden, Ronnie Aronson, Susan E. Kirsch, William G. Paterson, Margaret A. Marcon

Objective: To describe Celiac Disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in type 1 diabetes patients asymptomatic for CD.

Research Design and Methods: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring (CGM) over 12 months.

Results: Adults had higher CD-seropositivity rates than children (6.8%, 95%CI 4.9% to 8.2%, N=1298 vs. 4.7%; 95%CI 3.4% to 5.9%, N=1089, p=0.035) with lower rates of prior CD-screening (6.9% vs 44.2%, p<0.0001). 51 participants were randomized to a GFD (N=27) or GCD (N=24). No HbA1c differences were seen between groups (+0.14%, 1.5mmol/mol; 95%CI: -0.79 to 1.08; p=0.76) although greater post-prandial glucose increases (4-hr +1.5mmol/L; 95%CI: 0.4 to 2.7; p=0.014) emerged with a GFD.

Conclusions: CD is frequently observed in asymptomatic patients with type 1 diabetes and clinical vigilance is warranted with initiation of a GFD.