Verma Anjali, Rani Shilpi, Verma Surender, Khanna Alok
Pediatrics, PGIMS, Rohtak, Haryana, India.
General Surgery, PGIMS, Rohtak, Haryana, India.
J Family Med Prim Care. 2024 Oct;13(10):4252-4255. doi: 10.4103/jfmpc.jfmpc_186_24. Epub 2024 Oct 18.
Celiac disease (CD) in children can be associated with Type 1 Diabetes Mellitus (T1DM) as both share autoimmune etiology. Mainstay of treatment in celiac disease is total avoidance of gluten in diet whereas treatment in child with both the diseases will be Insulin therapy, exercise along with gluten free diet (GFD). There is dearth of literature regarding adherence to GFD and barriers for children with both T1DM and CD.
A questionnaire-based study was done at a tertiary care institute so as to compare the self-reported gluten adherence and the problems faced by children with dual diseases (TIDM and CD) and CD alone. Thirty children of age group 5-14 years each withType 1 DM and CD (T1DMCD group) and celiac disease (CD group) were selected consecutively. A questionnairewas filled by asking questions from either children (above 8 years) or parents (below 8 years) and the results were compiled, compared and further analysed.
Baseline demographic parameters were comparable in both the groups. Gluten adherence was found to be worse in T1DMCD group as compared to CD group. Greater number of problems were experienced by children with both TIDM and CD as compared to children with CD alone ( < 0.05). Financial burden more so in T1DMCD group, unawareness about disease and benefits of GFD, less availability and social isolation were found to be the most significant barriers to diet adherence.
As these children face dual diseases, they should be made more aware regarding benefits of GFD. Such information is valuable to primary care physicians for better management and rehabilitation of children suffering from these chronic diseases.
儿童乳糜泻（CD）可能与1型糖尿病（T1DM）相关，因为二者都有自身免疫病因。乳糜泻的主要治疗方法是在饮食中完全避免麸质，而同时患有这两种疾病的儿童的治疗方法是胰岛素治疗、运动以及无麸质饮食（GFD）。关于T1DM和CD患儿坚持GFD的情况以及障碍，相关文献较少。
在一家三级医疗机构进行了一项基于问卷调查的研究，以比较自我报告的麸质依从性以及患有双重疾病（T1DM和CD）的儿童和仅患有CD的儿童所面临的问题。连续选取了30名年龄在5 - 14岁的儿童，每组各15名，分别为1型糖尿病合并乳糜泻组（T1DMCD组）和乳糜泻组（CD组）。通过向8岁以上儿童或8岁以下儿童的家长提问来填写问卷，并对结果进行汇总、比较和进一步分析。
两组的基线人口统计学参数具有可比性。发现T1DMCD组的麸质依从性比CD组差。与仅患有CD的儿童相比，同时患有T1DM和CD的儿童遇到的问题更多（P < 0.05）。T1DMCD组的经济负担更重，对疾病和GFD益处的认识不足、GFD可获得性较低以及社交孤立被认为是饮食依从性的最主要障碍。
由于这些儿童面临双重疾病，应让他们更清楚地了解GFD的益处。这些信息对初级保健医生更好地管理和康复患有这些慢性病的儿童很有价值。
