medwireNews: Asymptomatic celiac disease (CD) is a frequently occurring comorbidity in people with type 1 diabetes, and transitioning to a gluten-free diet may increase postprandial glycemic variability, researchers report.
The CD-DIET study included 1298 adults and 1089 children with type 1 diabetes who did not have CD symptoms and underwent serologic screening for the condition. Farid Mahmud (University of Toronto, Ontario, Canada) and co-investigators identified “high rates” of screen-detected CD in the cohort, with seropositivity rates of 6.8% for adults and 4.7% for children, and biopsy-confirmed rates of 4.2% and 2.6%, respectively.
Asymptomatic CD was 1.5 times more common in adults compared with children, which was consistent with “changes in the symptom profile toward a more subtle and less classical malabsorptive presentation with increasing age,” and well-recognized “age-related increases in autoimmune comorbidities” among people with type 1 diabetes, say the study authors.
They also note that adults were significantly less likely to have undergone previous CD screening than children (6.9 vs 44.2%).
These findings suggest that “diabetes clinicians should be aware of CD as an important autoimmune comorbidity of type 1 diabetes that is frequently asymptomatic,” write Mahmud and team.
Following the screening part of the study, 51 participants with biopsy-confirmed CD were randomly assigned to follow a gluten-free or a gluten-containing (control) diet for 1 year. During this period, average glycated hemoglobin levels increased by 0.30% (3.3 mmol/mol) in the gluten-free diet group and by approximately 0.20% in the control group, with no significant difference between the groups.
There were also no significant differences in growth parameters (height, weight, and BMI), insulin dose, and rates of hypoglycemia among people following the gluten-free versus gluten-containing diet.
However, participants in the gluten-free diet arm experienced significant increases in glucose levels after eating a meal, with average levels increasing by 1.6 mmol/L (28.9 mg/dL) at the 2-hour postprandial timepoint, and by 1.5 mmol/L (27.1 mg/dL) at 4 hours, whereas postprandial glucose levels returned to pre-meal levels within 4 hours in the control group.
These findings suggest that “clinical vigilance is warranted during dietary transition, as [gluten-free diet]-treatment may impact short-term glycemic variability,” conclude Mahmud et al in Diabetes Care.
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Diabetes Care 2020; doi:10.2337/dc19-1944