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Endocrinology and diabetes

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N Abid, C Cardwell, W McCallion, D Carson. Royal Belfast Hospital for Sick Children, Belfast, UK

Aims: To determine the clinical and metabolic effects of gluten-free diet (GFD) in a group of children with type 1 diabetes with coeliac disease.

Methods: Data were collected for all patients with type 1 diabetes screened between November 2000 and November 2007 for high titres of antiendomysial, antitransglutaminase and antigliadin antibodies. A diagnosis of coeliac disease was confirmed by small bowel biopsy. The variables considered before diagnosis of coeliac disease and after 12 months of GFD included gastrointestinal symptoms, episodes of severe hypoglycaemia, serology, height, weight, body mass index (BMI), insulin requirements, haemoglobin A1c and haemoglobin levels.

Results: 468 children with type 1 diabetes were screened for coeliac disease during a 7-year period in a single unit. 23 patients were identified with a female to male ratio of 2.4 : 1. Three patients were excluded from the study due to incomplete follow-up. Mean age at diagnosis of type 1 diabetes was 6.7 years, whereas the mean age at diagnosis of coeliac disease was 11 years. At diagnosis of coeliac disease, 11 children had gastrointestinal symptoms. After GFD the symptoms improved in all but one patient. The mean SDS for height, weight and BMI in the study group before and after treatment remained within 1 SDS; however, the height SDS was lower compared with the weight SDS (mean of height SDS −0.14 to −0.17 and weight SDS 0.34 to 0.40). Eight patients continued to be seropositive despite 12 months of GFD. The mean insulin requirement of the whole group increased after GFD from 0.93 units/kg per day to 1.05 units/kg per day, which was found to be statistically significant (t  =  −2.38, df  =  19, p<0.05). No significant change in haemoglobin A1c was …

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