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Significance of Screening Detected Celiac Disease in Children with Type I Diabetes (A Case Control Study)

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. 

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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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4 Responses:

 
an unknown user
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said this on
11 Nov 2007 4:31:52 PM PDT
I have a biochemistry degree and have worked with pharmaceutical research and the wording of this article made it difficult for me to follow how these children were diagnosed, if they were on a gluten-free diet, and if they had celiac disease before or after their diabetes diagnosis.

 
Colleen Karney
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said this on
11 Nov 2007 7:32:45 PM PDT
I guess he's saying that, absent free health care assistance for celiac children, the medical community is reluctant to offer celiac screening to all children. A broad-based celiac disease screening program, he suggests, would raise psychological, cost, and ethical issues. On the other hand, leaving celiac children undiagnosed also raises psychological issues (celiac disease contributes to depression and other mental health effects), cost issues (greater expense associated with a decade or more of wrong medical treatments and possible hospitalization for celiac disease patients who are not diagnosed until their teenage or adult years), and ethical issues (is it ethical to tell undiagnosed celiac disease patients that their poor concentration is their own fault; that they just need to 'pull out' of their depression; that they need to eat more whole grains, like wheat, oats, and barley, to ease their constipation; that there is no known cause for their IBS, skin, or hair problems; or that their 'gas' problems are triggered by unidentifiable 'wrong' foods?). If the medical community is waiting until families can have a special celiac disease assistant available to help them find and cook gluten-free food, navigate the school cafeteria and restaurants, and obtain financial assistance, then the medical community should lobby for whatever help is needed to help doctors feel comfortable in telling families how to keep their children healthy. For celiac disease families, good health is not possible without the early screening that US doctors are so reluctant to provide.

 
Murali Jatla
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said this on
15 Nov 2007 11:42:00 AM PDT
Thanks for the the above comments. As stated in the summary the celiac disease was diagnosed 3.5 years after diabetes. Celiac screening was performed yearly after diabetes diagnosis and all celiacs were recommended a gluten-free diet. The article has been modified to reflect these clarifications.

The trouble with silent celiac disease in diabetes does not lie in screening. Screening is recommended for all type 1 diabetic children--it is recommended by major pediatric societies and must be performed. Making a diagnosis is not difficult, from a pediatric gastroenterologist's perspective. The true challenge lies in appropriately counseling an asymptomatic diabetic child's family when they are diagnosed with silent celiac disease. It is challenging to adjust to another condition that requires further dietary modification. The benefits of treating silent celiac disease in type 1 diabetic children is unknown and this largest, best-performed study found no significant improvements. Perhaps a follow-up period longer than 3.3 years is required to see any true effects.

A separate, perhaps more important, question is whether type I diabetes was secondary to silent celiac disease and whether it may have been prevented by celiac screening at an earlier age. It is unethical to perform a trial where we test a group of children at infancy and randomize them to regular diet or gluten-free diet and look 15 years later to see how many develop diabetes in the two groups. The question of universal screening is a very important one that will hopefully be settled soon. However, there should be no question regarding screening for celiac disease in type I diabetes, although the data supporting treatment is in evolution.

 
Scott Adams
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said this on
16 Nov 2007 1:56:55 PM PDT
Thank you for the clarifications Dr. Jatla!




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Celiac.com Celiac Disease & Gluten-Free Diet Forum - All Activity

JMG got it down pretty much, the painful and gluten effects from eating it should clear up in a month, damage symptoms you might notice some differences as early as 2-4months but most do not noticed major improvements til about 6 months to a year. I have been gluten-free for over 3 years all my villi have healed according to the doctor on my last scope. It is very important to not cheat and avoid any kind of CC as it can set you back weeks or months. I would suggest a whole foods only diet for the first month or two, no dairy, simple stews, soups, etc. make for easy to digest and simple meals. Check out the 101 thread for some good information. PS a new combo crockpot, steamer, rice cooker combo and liners for a crock pot will be a life saver for making simple meals and easy clean ups. Quick cook microwave ware will also be handy making sure you have gluten-free cooked meals if you can not get new cookware immediately. I normally suggest cleaning out the entire house, scrubbing down knobs, handles, on the drawers, sink, fridge, cubbards etc. throw out condiment jars, checking ingredients on everything in the house including your hygiene and makeup. Putting in drawer organizers for new utensils, throwing out scratched glass, teflon, plastic, and steel cookware. Throwing out any Tupperware, and cutting boards, some utensils that can not be cleaned well. Some times you can save cast iron and stainless steel cook ware if you can run it in your ovens cleaning cycle over 600F. Gluten is a protein like blood if you can not clean a item where a CSI team will not find it give it up, it is not a germ that can be killed with disinfectant. I use freezer paper for clean prep surfaces, also makes clean up a breeze, I tend to use gloves alot also when fixing foods,

Hi Allie and welcome First off, I know 3 years was a long wait, but at 17 you've figured out celiac way before many people do. That should make a big impact on minimising its effects and helping you with the diet, so, bizarrely enough, congratulations! A lot of good advice has been brought together in this thread: Don't worry that your symptoms are bad now. As you follow the diet your body will begin healing itself and you're still very young so hopefully this will go really smoothly. Think in terms of the next 6 months rather than weeks however, recovery will likely take a little time. Eat as healthily as you can, lots of whole foods and try to avoid the gluten free processed substitutes as your digestive system needs all the help it can get at this moment. You may want to avoid dairy as well for now and think about reintroducing it later. This site has been really helpful to me and others. I hope you find it just as useful. Best of luck! ps, your increased reaction to gluten during the challenge phase was perfectly normal. Many find that reintroducing it much worse than the initial affects and take some time to get over the challenge. That's why you'll see lots of posts here urging folks to 'stay on gluten' till their testing is complete!

Hi! My daughter is 19 was diagnosed at age 16. It took about 12-18 month s for her to fully heal from the damage and feel "normal" again. Also because of the damage done she had reactions to dairy, so you may want to try no or minimum dairy until youre fully healed. Just a suggestion. Hope you start feeling well soon!

Hi yall! New to this blog, but really glad it exists because I have lots of questions. First off, I'm Allie! I'm 17 and newly diagnosed Celiac after about 3 years of searching for answers. I initially went gluten-free on the recommendation of a friend, I felt better in about a month and then my pediatric gastroenterologist had me do the gluten challenge, and my symptoms were the worst they have ever been, and ones I barely noticed before became very present. I did the biopsy and was diagnosed, it's been about 2 weeks and my symptoms are still pretty bad, although my diet has no known sources of gluten or cross contamination. Wondering if anyone has any input on healing post gluten challenge, any tips or how long it took for you would be quite helpful! Thanks

Might want to look into a keto diet, I have UC on top of celiacs and keto is working great Yeah I have major nerve and brain issues with gluten, gluten ataxia with nerve issues and brain issues. Seems to cause my body to attack my brain and nerve system. My brain stumbles fogs, and starts looping, the confusion causes me to become really irritable, I call it going Mr Hyde. Like my mind will start looping constantly on thoughts and not move driving me literally mad, or it used to. Now days it is primary the numbness anger but the gut issues and sometimes random motor loss limit me motionless to the floor now days for the duration of the major anger effects. Used to be a lot more mental then painful gut. I did a mental trauma post on it on while back where I came out about all my mental issues with gluten.