Objectives: Data on the role of gluten in type 1 diabetes (T1D) pathogenesis are scarce. We aimed to test whether gluten-free diet (GFD) can decelerate the decline in beta-cell capacity in newly diagnosed non-coeliac T1D children.
Methods: Forty six children (aged 10.2±3.3 years) were recruited into this non-randomized self-selected intervention trial: 26 started with GFD, whereas 20 remained on standard 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. The adherence to GFD was tested by immunoreactive gluten in stool and food questionnaires at every visit. The quality of life (QoL) questionnaires were given to the patients and their parents at 12 months. Data were analyzed per protocol by linear and longitudinal regression models adjusted for sex, age and baseline HbA1c, insulin dose, C-peptide AUC and IDAA1c.
Results: A total of 39 patients (20 GFD group, 19 controls) were subject to final analysis. Immunoreactive gluten was found in the stool of 4 patients from the GFD group. The difference in trends of C-peptide decline between the groups was statistically significant at 32.6 pmol/L per month (p=0.04). The mean decrease in C-peptide AUC was 567 vs 919 pmol/L (p=0.1) at 12 months in GFD and control group, respectively. The GFD group had a lower insulin dose by 0.17 U/kg/day (p=0.04), lower IDAA1c by 1.51 (p=0.006) and lower mean HbA1c by 9 mmol/mol (p=0.004) at 12 months. There was no difference in daily carbohydrate intake between the groups (p=0.83). There was no statistically significant difference in QoL between the groups as reported by the patients nor their parents (p=0.70, p=0.59).
Conclusions: GFD kept over the first year after T1D diagnosis shows great promise as it was associated with lower C-peptide decline, lower insulin demand and HbA1c and more pronounced partial remission period.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology