Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy.
Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy.
Diabetes Res Clin Pract. 2022 Sep;191:110032. doi: 10.1016/j.diabres.2022.110032. Epub 2022 Aug 4.
To evaluate the impact of gluten free diet (GFD) on growth, metabolic control and quality of life in children and adolescents with type 1 diabetes (T1D) and celiac disease (CD).
A systematic search was performed including studies published in the last 15 years. PICOS framework was used in the selection process and evidence was assessed using the GRADE system.
Overall, studies comparing youth with T1D + CD on GFD to those with T1D only, showed no significant differences in growth parameters, HbA1c, number of episodes of hypoglycemia, total daily insulin doses. Studies assessing the effect of GFD introduction showed stable BMI and HbA1c. Only two studies assessed QoL of life, which was not different between T1D + CD vs T1D only youth, as well as pre- and post-CD diagnosis and introduction of GFD.
This systematic review, including only studies of moderate-high evidence quality level and reporting data on objectively assessed adherence to GFD, highlights that adherence to GFD in youth with T1D + CD leads to regular growth, stable BMI, without any negative effect on HbA1c and insulin requirements. Although assessed in few studies, lipid profile and QoL improved with the introduction of GFD.
评估无麸质饮食（GFD）对 1 型糖尿病（T1D）和乳糜泻（CD）患儿和青少年的生长、代谢控制和生活质量的影响。
进行了系统检索，包括过去 15 年发表的研究。在选择过程中使用了 PICOS 框架，并使用 GRADE 系统评估证据。
总体而言，将同时患有 T1D 和 CD 的青少年与仅患有 T1D 的青少年进行比较的研究表明，生长参数、HbA1c、低血糖发作次数和总日胰岛素剂量均无显著差异。评估 GFD 引入效果的研究显示 BMI 和 HbA1c 稳定。只有两项研究评估了生活质量，同时患有 T1D 和 CD 的青少年与仅患有 T1D 的青少年之间、以及 CD 诊断前和 GFD 引入前后的生活质量并无差异。
本系统评价仅包括中高质量证据水平的研究，并报告了客观评估 GFD 依从性的数据，强调了 T1D 合并 CD 的青少年坚持 GFD 可实现正常生长、稳定 BMI，且不会对 HbA1c 和胰岛素需求产生任何负面影响。尽管在少数研究中进行了评估，但引入 GFD 后血脂谱和生活质量有所改善。
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