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Growth and metabolic control in patients with type 1 diabetes and celiac disease: a longitudinal observational case–control study

Authors

  • Irit Taler,

    1. Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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  • Moshe Phillip,

    1. Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Yael Lebenthal,

    1. Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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  • Liat de Vries,

    1. Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Raanan Shamir,

    1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    2. Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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  • Shlomit Shalitin

    Corresponding author
    1. Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
    2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    • Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Corresponding author:

Shlomit Shalitin, MD

Institute for Endocrinology and Diabetes

National Center for Childhood Diabetes

Schneider Children's Medical Center of Israel

14 Kaplan Street

Petach Tikva 49202, Israel.

Tel: +972-3-925 3731;

fax: +972-3-925 3836.

e-mail: shalitin@netvision.net.il

Abstract

Background

The occurrence of celiac disease (CD) in patients with type 1 diabetes (T1D) is increasing.

Objective

To determine the effect of CD on growth and glycemic control in patients with T1D, and the effects of adherence to gluten-free diet (GFD) on these parameters.

Patients and methods

A longitudinal retrospective case–control design was used. The medical files of 68 patients with T1D and duodenal-biopsy-confirmed CD were reviewed for data on weight, height, hemoglobin A1c (HbA1c), frequency of diabetic ketoacidosis (DKA), and severe hypoglycemic events before and after diagnosis and treatment of CD. Findings were compared with 131 patients with T1D only matched for age, gender, and duration of diabetes.

Results

CD was diagnosed in 5.5% of all patients with T1D attending our center during the study period; 26% of the patients with CD were symptomatic. There were no significant differences in glycemic control or frequency of severe hypoglycemia or DKA events between the study and control groups. Body mass index-standard deviation score (SDS), height-SDS, and HbA1c values were marginally but not significantly higher in the control than the study group and similar in subjects with CD with good or fair/poor adherence to a GFD throughout follow-up.

Conclusions

Patients with T1D and CD treated with GFD have growth and measures of metabolic control similar to those with T1D without CD. The decision whether asymptomatic celiac patients should be put on a GFD or only symptomatic patients has to be weighed against possible short- and long-term consequences of no intervention, and should be based on more evidence from larger randomized studies.

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