Coeliac disease, gluten-free diet and the development and progression of albuminuria in children with type 1 diabetes

Authors

  • Esha Gopee,

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Eva LM van den Oever,

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
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  • Fergus Cameron,

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
    2. Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
    3. Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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  • Merlin C Thomas

    Corresponding author
    1. JDRF/Danielle Alberti Memorial Centre for Diabetes Complications, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
    • Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
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Corresponding author: Prof Merlin Thomas, MCBcB, PhD, FRACP,

Baker IDI Heart and Diabetes Institute,

PO Box 6492,

Melbourne, VIC 8008,

Australia.

Tel: (61) 3-85321277;

fax: (61) 3-85321480;

e-mail: mthomas@baker.edu.au

Abstract

Objectives

Although a diagnosis of coeliac disease (CD) may be confronting to children with type 1 diabetes and their families, we hypothesize that children with CD have lower urinary albumin excretion, a marker of renal dysfunction.

Research design

Twenty-four children with type 1 diabetes and biopsy-proven CD, on a gluten-free diet for at least 1 yr, were recruited from a single paediatric diabetes clinic alongside 55 children with type 1 diabetes but without CD matched for age, gender, duration of diabetes, and glycaemic control.

Results

Despite comparable diabetes exposure, glycaemic control and nutritional status, children with type 1 diabetes and CD had a lower urinary albumin creatinine ratio than in diabetic subjects without CD (0.9 ± 0.3 mg/mmol vs. 1.6 ± 0.3 mg/mmol; p = 0.01). Participants with CD also showed slower progression in albuminuria over 5-yr of follow-up while a small but significant increase was observed in the children with diabetes alone (1.6 ± 0.3 mg/mmol; follow-up 2.4 ± 0.5 mg/mmol; p = 0.02).

Conclusions

As urinary albumin excretion is continuously associated with the risk of kidney disease, it is possible to speculate that CD or its management confers a degree of renoprotection. Larger studies are required to test this hypothesis.

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