Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study.

Abstract

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA_1c and continuous glucose monitoring over 12 months. Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, <i>N</i> = 1,298] vs. 4.7% [95% CI 3.4-5.9%, <i>N</i> = 1,089], <i>P</i> = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, <i>P</i> < 0.0001). Fifty-one participants were randomized to a GFD (<i>N</i> = 27) or GCD (<i>N</i> = 24). No HbA_1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI -0.79 to 1.08; <i>P</i> = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4-2.7; <i>P</i> = 0.014) emerged with a GFD. CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.