Does Gluten Play a Role in the Onset of Type 1 Diabetes?

Celiac.com 07/04/2019 - There's been some data to suggest that gluten may play a role in diabetes, but there really isn't much data on the role of gluten in type 1 diabetes (T1D), so a team of researchers recently set out to test whether gluten plays a role in type 1 diabetes onset. Specifically, the team wanted to know if a gluten-free diet can decelerate the decline in beta-cell capacity in newly diagnosed non-celiac children with T1D.

The research team included Vít Neuman, Stepanka Pruhova, Michal Kulich, Stanislava Kolouskova, Jan Vosahlo, Martina Romanova, Lenka Petruzelkova, Barbora Obermannova, Ondrej Cinek, and Zdeněk Šumník. They are variously affiliated with Charles University in Prague, and the University of Chemistry and Technology in Prague, Czech Republic.

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For their non-randomized self-selected intervention trial, the team recruited forty-six children, from about 6-13 years old. One group of 26 began a gluten-free diet, while 20 continued on a standard non-gluten-free diet. 

Main outcomes were the decline in C-peptide area under the curve (AUC) in mixed-meal tolerance tests and the differences in insulin dose, insulin dose adjusted A1c (IDAA1c) and HbA1c at 12 months. 

Data were analyzed as intention-to-treat by linear regression models adjusted for baseline parameters. The adherence to a gluten-free diet was tested by immunoreactive gluten in stool.

Average decrease in C-peptide AUC was 293 vs.484 pmol/L (p=0.3) at 6 months, and 567 vs. 919 pmol/L (p=0.1) at 12 months in the gluten-free diet and control group, respectively. 

The group that ate a gluten-free diet had a lower insulin dose by 0.22 U/kg/day, lower IDAA1c by 1.5, and lower average HbA1c by 7.5 mmol/mol (p=0.01) after 12 months. Daily carbohydrate intake between the groups was the same. Researchers found immunoreactive gluten in the stool of just 3 patients.

Children with type 1 diabetes who ate a gluten-free diet for their first year after diagnosis lower insulin demand and lower HbA1c, although C-peptide dynamics were similar for each group.

This is the first study to provide solid data on the connection between gluten intake and type 1 diabetes. The fact that children who follow a gluten-free diet need less insulin is intriguing.

Read more at Diabetes 2019 Jun; 68(Supplement 1).