Söderström Hanna, Cervin Matti, Dereke Jonatan, Hillman Magnus, Tiberg Iren, Norström Fredrik, Carlsson Annelie
Department of Clinical Sciences, Pediatrics, Skåne University Hospital Lund, Lund University, Lund, Sweden.
Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
Contemp Clin Trials Commun. 2022 Feb 16;26:100893. doi: 10.1016/j.conctc.2022.100893. eCollection 2022 Apr.
Increasing evidence suggests a link between type 1 diabetes (T1D) and intake of gluten, but no controlled trials have examined whether a gluten-free diet (GFD) has positive effects on glycemic control in children with T1D.
We conducted a non-randomized feasibility study. Twenty-three children with newly diagnosed T1D were included and either followed a GFD (n = 14) or a normal diet (n = 9) for 12 months. Effects of diet on glycemic control were examined by measuring insulin production (c-peptide), hemoglobine A1c (HbA1c) and insulin dose adjusted A1c (IDAA1c). Degree of adherence to the GFD and effects on quality of life were also examined.
Children on a GFD showed a statistically significantly lower HbA1c at six months (P = 0.042) compared with children on a normal diet and point estimate differences indicated better glycemic control in the GFD group at 6 and 12 months. Adherence to a GFD varied but was satisfactory for a majority of children. The GFD group reported poorer quality of life at inclusion and there was a non-significant difference for quality of life between groups throughout the study.
A strict GFD can be maintained by children with newly diagnosed T1D and may have positive effects on glycemic control. Our findings should be interpreted carefully because of small samples and possible confounding. We provide recommendations for future trials and suggest using a randomized-controlled design with 30-40 participants in each arm.
越来越多的证据表明1型糖尿病（T1D）与麸质摄入之间存在联系，但尚无对照试验研究无麸质饮食（GFD）对T1D儿童血糖控制是否有积极影响。
我们进行了一项非随机可行性研究。纳入23名新诊断为T1D的儿童，让他们要么遵循GFD（n = 14），要么遵循正常饮食（n = 9），为期12个月。通过测量胰岛素生成（C肽）、糖化血红蛋白（HbA1c）和胰岛素剂量调整糖化血红蛋白（IDAA1c）来检查饮食对血糖控制的影响。还检查了对GFD的依从程度及其对生活质量的影响。
与遵循正常饮食的儿童相比，遵循GFD的儿童在6个月时HbA1c在统计学上显著更低（P = 0.042），点估计差异表明GFD组在6个月和12个月时血糖控制更好。对GFD的依从情况各不相同，但大多数儿童的依从情况令人满意。GFD组在纳入时报告生活质量较差，并且在整个研究过程中两组之间的生活质量存在非显著差异。
新诊断为T1D的儿童可以维持严格的GFD，并且这可能对血糖控制有积极影响。由于样本量小和可能存在混杂因素，我们的研究结果应谨慎解读。我们为未来的试验提供了建议，并建议采用随机对照设计，每组有30 - 40名参与者。
