Amin Rakesh, Murphy Nuala, Edge Julie, Ahmed Marion L, Acerini Carlo L, Dunger David B
University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK.
Diabetes Care. 2002 Jul;25(7):1117-22. doi: 10.2337/diacare.25.7.1117.
To describe the longitudinal growth characteristics and glycemic control in type 1 diabetic children diagnosed with celiac disease and started on a gluten-free diet (GFD).
Data on growth and glycemic control for 11 case subjects diagnosed with celiac disease (cd(+) group) and started on a GFD were collected prospectively, and two control subjects without celiac disease matched for age, sex, and duration of diabetes (cd(-) group) were selected for comparison.
In the period between diagnosis of type 1 diabetes and start of a GFD in the cd(+) compared with the cd(-) group, BMI standard deviation score (SDS) was lower (-0.2 vs. 0.7, P = 0.015), as was HbA(1c) (8.9 vs. 9.8%, P = 0.002). In a regression model the cd(+) group had lower BMI SDS (P < 0.001) and lower HbA(1c) (P = 0.04), independent of other variables. On a GFD, BMI SDS increased by 12 months in the cd(+) group and then was no different than the cd(-) group (1.1 vs. 1.0, P = 0.11), whereas HbA(1c) improved further within case subjects compared with pre-GFD (8.9 vs. 8.3%, P = 0.002). On a GFD, case subjects in contrast to control subjects showed no deterioration in HbA(1c) during the years of puberty (8.3 vs. 10.0%, P = 0.022)
In children with type 1 diabetes, untreated celiac disease resulted in lower BMI SDS and lower HbA(1c). Recovery of BMI SDS with a GFD was associated with further improvement in HbA(1c) as compared with pre-GFD, with no expected deterioration in glycemic control during puberty. These apparent clinical benefits need confirming by larger studies.
描述确诊为乳糜泻并开始采用无麸质饮食（GFD）的1型糖尿病儿童的纵向生长特征和血糖控制情况。
前瞻性收集11例确诊为乳糜泻（cd(+)组）并开始采用GFD的病例的生长和血糖控制数据，并选取2例年龄、性别和糖尿病病程相匹配的无乳糜泻对照对象（cd(-)组）进行比较。
在1型糖尿病确诊至cd(+)组开始采用GFD期间，与cd(-)组相比，BMI标准差评分（SDS）较低（-0.2对0.7，P = 0.015），糖化血红蛋白（HbA(1c)）也较低（8.9%对9.8%，P = 0.002）。在回归模型中，cd(+)组的BMI SDS较低（P < 0.001），HbA(1c)也较低（P = 0.04），与其他变量无关。采用GFD后，cd(+)组的BMI SDS在12个月时有所增加，然后与cd(-)组无差异（1.1对1.0，P = 0.11），而与采用GFD前相比，病例组内的HbA(1c)进一步改善（8.9%对8.3%，P = 0.002）。采用GFD后，与对照对象相比，病例对象在青春期期间HbA(1c)没有恶化（8.3%对10.0%，P = 0.022）。
在1型糖尿病儿童中，未经治疗的乳糜泻导致较低的BMI SDS和较低的HbA(1c)。与采用GFD前相比，采用GFD后BMI SDS的恢复与HbA(1c)的进一步改善相关，且青春期期间血糖控制没有预期的恶化。这些明显的临床益处需要通过更大规模的研究来证实。
