1型糖尿病合并乳糜泻患者的生活质量：无麸质饮食的作用。
Quality of Life in Type 1 Diabetes and Celiac Disease: Role of the Gluten-Free Diet.
作者信息
Pham-Short Anna, Donaghue Kim C, Ambler Geoffrey, Garnett Sarah, Craig Maria E
机构信息
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
J Pediatr. 2016 Dec;179:131-138.e1. doi: 10.1016/j.jpeds.2016.08.105. Epub 2016 Oct 5.
OBJECTIVE
To evaluate quality of life (QoL) and glycemic control in youth with type 1 diabetes (T1D) and celiac disease vs T1D only. We hypothesized that QoL scores would be lower in youth with T1D and celiac disease and those nonadherent to the gluten-free diet (GFD).
STUDY DESIGN
This case control study included 35 youth with T1D and 35 with T1D and celiac disease matched for age, sex, diabetes duration, and hemoglobin A1c level. QoL was assessed in participants and parents using the Pediatric Quality of Life Inventory Generic Core Scale, Pediatric Quality of Life Inventory Diabetes Module. and the General Well-Being Scale; youth with T1D and celiac disease also completed the celiac disease-specific DUX questionnaire and parents completed the Pediatric Quality of Life Inventory Family Impact Scale. Questionnaires were scored from 0 to 100; higher scores indicate better QoL or well-being. Scores were compared between T1D vs T1D with celiac disease, with subgroup analysis by GFD adherence vs nonadherence and therapy (continuous subcutaneous insulin infusion vs multiple daily injections).
RESULTS
Youth with T1D and celiac disease reported similar generic and diabetes-specific QoL to T1D only. GFD nonadherent vs adherent youth reported lower diabetes-specific QoL (mean score 58 vs 75, P = .003) and lower general well-being (57 vs 76, P = .02), as did their parents (50 vs 72, P = .006), and hemoglobin A1c was higher (9.6% vs 8.0%, P = .02). Youth with T1D and celiac disease using continuous subcutaneous insulin infusion vs multiple daily injections had similar generic and diabetes-specific QoL and A1C (8.6 vs 8.2%, P = .44), but were less happy having to follow a lifelong diet (59 vs 29, P = .007).
CONCLUSIONS
Youth with T1D and celiac disease who do not adhere to the GFD have lower QoL and worse glycemic control. Novel strategies are required to understand and improve adherence in those with both conditions.
目的
评估1型糖尿病（T1D）合并乳糜泻的青少年与仅患T1D的青少年的生活质量（QoL）和血糖控制情况。我们假设，T1D合并乳糜泻的青少年以及那些不坚持无麸质饮食（GFD）的青少年的生活质量评分会更低。
研究设计
这项病例对照研究纳入了35名T1D青少年和35名T1D合并乳糜泻的青少年，他们在年龄、性别、糖尿病病程和糖化血红蛋白水平方面相匹配。使用儿童生活质量普适性核心量表、儿童生活质量糖尿病模块和总体幸福感量表对参与者及其父母进行生活质量评估；T1D合并乳糜泻的青少年还完成了乳糜泻特异性DUX问卷，父母完成了儿童生活质量家庭影响量表。问卷评分范围为0至100分；分数越高表明生活质量或幸福感越好。比较了T1D组与T1D合并乳糜泻组的得分，并按GFD依从性与非依从性以及治疗方式（持续皮下胰岛素输注与每日多次注射）进行亚组分析。
结果
T1D合并乳糜泻的青少年报告的普适性和糖尿病特异性生活质量与仅患T1D的青少年相似。GFD非依从性青少年与依从性青少年相比，糖尿病特异性生活质量得分更低（平均得分58分对75分，P = .003），总体幸福感得分也更低（57分对76分，P = .02），他们的父母也是如此（50分对72分，P = .006），且糖化血红蛋白水平更高（9.6%对8.0%，P = .02）。使用持续皮下胰岛素输注与每日多次注射的T1D合并乳糜泻的青少年，其普适性和糖尿病特异性生活质量以及糖化血红蛋白水平相似（8.6%对8.2%，P = .44），但在不得不遵循终身饮食方面不太开心（59分对29分，P = .007）。
结论
不坚持GFD的T1D合并乳糜泻的青少年生活质量更低，血糖控制更差。需要新的策略来理解并提高患有这两种疾病的青少年的依从性。
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