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Significance of Screening Detected Celiac Disease in Children with Type I Diabetes (A Case Control Study)
Dr. Murali Jatla
Dr. Murali Jatla is a pediatric gastroenterologist at the Children's Hospital at Scott & White Hospital in Round Rock and Temple, Texas. He was a former fellow at the Children's Hospital of Philadelphia (CHOP) and helped to start the Celiac Center at CHOP, where patient care, clinical research, nutrition and education occur in a multidisciplinary manner.View all articles by Dr. Murali Jatla
Celiac.com 11/06/2007 - This study investigated the effect of screening detected celiac disease in type I diabetic children in a multi-center case-control fashion. The research team consisted of B Rami, Z Sumni, E Schober et al from Austria, Czech Republic, and Slovenia, among other European countries.
The team compared 98 diabetics with silent celiac disease to 196 control diabetics without celiac matched for age, sex, diabetes duration. Mean age at diabetes diagnosis was 6.5 yrs, celiac diagnosis was 10.0 yrs. Celiac screening included yearly antibody testing and positive patients underwent biopsy. Hemoglobin A1c, hypoglycemia, ketoacidosis, insulin dosage, body-mass index, and height did not differ between cases and controls at celiac diagnosis or after a mean follow-up of 3.3 years. After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared to their controls.
Although a clear link between type I diabetes and increased risk of celiac disease is established, the benefit of a gluten-free diet is unclear in these children. This study followed 98 patients with diabetes and silent celiac for a mean of 3.3 years and compared them to 196 controls. This is the largest, best designed case-control study to date and it did not demonstrate any significant differences between the two groups, except for a decreased Body Mass Index (BMI - though still greater than non-diabetic, control children) in males after diagnosis.
What is more intriguing is that at diagnosis, no significant differences in height, BMI, HbA1c, insulin need, or hypoglycemia events were seen, questioning the metabolic significance of silent celiac disease. In this study, it is difficult to estimate the duration of silent celiac disease prior to diagnosis. Although, given the fact that these patients were asymptomatic and their mean diabetes duration was 3.6 years, it likely implies that silent celiac disease was present for a few years.
The data regarding the benefit of a gluten-free diet in screening detected celiac disease in type I diabetic children is scant but is slowly increasing. Numerous psychological (burden of gluten free diet in addition to diabetic diet), cost (of diet), and ethical issues (potential long-term benefits of gluten-free diet, compliance with diet) exist regarding these children and hopefully this question will be answered soon and with good, convincing data.
Journal of Pediatric Gastroenterology and Nutrition, 41:317-321, 2005
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