Department of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden.
Skåne University Hospital, 221 85 Lund, Sweden.
Nutrients. 2021 Dec 13;13(12):4444. doi: 10.3390/nu13124444.
Children with type 1 diabetes (T1D) are at increased risk of celiac disease (CD). The replacement of insulin in T1D, and the exclusion of gluten in CD, are lifelong, burdensome treatments. Compliance to a gluten-free diet (GFD) in children with CD is reported to be high, while compliance in children with both diseases has scarcely been studied. To examine compliance to a GFD in children with both T1D and CD, we analyzed tissue transglutaminase IgA-antibodies (tTGA). Moreover, associations between compliance and age, sex, glycemic control, ketoacidosis (DKA), body mass index (BMI), and time of CD diagnosis were investigated. Of the 743 children diagnosed with T1D in southern Sweden between 2005 and 2012, 9% were also diagnosed with CD. Of these, 68% showed good compliance to a GFD, 18% showed intermediate compliance, and 14% were classified as non-compliant. Higher age, poorer HbA1c, and more DKAs were significantly ( < 0.05) associated with poorer compliance. In conclusion, we found that compliance to a GFD in children with T1D and CD is likely be lower than in children with CD only. Our results indicate that children with both T1D and CD could need intensified dietary support and that older children and children with poor metabolic control are especially vulnerable subgroups.
患有 1 型糖尿病（T1D）的儿童患乳糜泻（CD）的风险增加。T1D 患者需要用胰岛素替代治疗，而 CD 患者需要终身严格无麸质饮食，这两种治疗都很繁琐。据报道，CD 患儿对无麸质饮食（GFD）的依从性较高，而同时患有这两种疾病的患儿的依从性研究甚少。为了研究同时患有 T1D 和 CD 的患儿对 GFD 的依从性，我们分析了组织转谷氨酰胺酶 IgA 抗体（tTGA）。此外，还研究了依从性与年龄、性别、血糖控制、酮症酸中毒（DKA）、体重指数（BMI）和 CD 诊断时间之间的关系。在 2005 年至 2012 年期间，瑞典南部共诊断出 743 例 T1D 患儿，其中 9%也被诊断出患有 CD。其中，68%的患儿对 GFD 有良好的依从性，18%的患儿有中等程度的依从性，14%的患儿被归类为不依从。较高的年龄、较差的 HbA1c 和更多的 DKA 与较差的依从性显著相关（<0.05）。总之，我们发现 T1D 和 CD 患儿对 GFD 的依从性可能低于仅患有 CD 的患儿。我们的结果表明，同时患有 T1D 和 CD 的患儿可能需要加强饮食支持，年龄较大和代谢控制较差的患儿是特别脆弱的亚组。
