Hatlen Kristine Vaage, Lysell Lensnes Therese Margrethe, Henriksen Christine, Berg Tore Julsrud, Nermoen Ingrid, Lundin Knut Erik Aslaksen
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
Scand J Gastroenterol. 2025 Jan;60(1):28-36. doi: 10.1080/00365521.2024.2442688. Epub 2024 Dec 22.
Concurrent type 1 diabetes (T1D) and celiac disease (CeD) pose challenges in insulin dosage adjustments and gluten-free dietary adherence. Urine testing for gluten immunogenic peptides (GIP) is a new method to detect gluten exposure within the last 3-12 h. Our aims were to compare gluten-free dietary adherence between T1D + CeD and CeD individuals and evaluate urinary GIP testing in an outpatient setting.
This observational cross-sectional study included three adult groups: (1) T1D and CeD, (2) CeD only, and (3) T1D only. T1D participants were recruited from outpatient clinics, the CeD group via social media. One urine sample (12 pm-7 pm) was analyzed using a qualitative immunographic GIP test. CeD participants completed 'Celiac Dietary Adherence Test' (CDAT) and 'Celiac Symptom Index' (CSI) questionnaires. IgA anti-transglutaminase 2 (IgA-TG2) and IgG anti-deamidated gliadin (IgG-DGP) serology were also analyzed.
197 participants, mean (SD) age 43 (15) years, were included. Female percentages were: CeD: 90%, T1D + CeD: 64%, and T1D: 47%. Positive urinary GIP was found in 15% (14/96) of T1D + CeD and 0% (0/50) of CeD ( = 0.002). As expected, most T1D only participants had positive urinary GIP (86%, 44/51). CDAT and CSI scores did not differ between T1D + CeD and CeD groups. Positive IgA-TG2 and/or IgG-DGP levels were found in 12% of T1D + CeD and 6% of CeD participants ( = 0.38).
A single GIP urine test revealed higher gluten exposure in T1D + CeD versus CeD only, questioning dietary adherence in this population. Urinary GIP tests can be useful for clinical follow-up.
1型糖尿病（T1D）与乳糜泻（CeD）并存给胰岛素剂量调整和无麸质饮食依从性带来挑战。检测麸质免疫原性肽（GIP）的尿液检测是一种检测过去3 - 12小时内麸质暴露情况的新方法。我们的目的是比较T1D + CeD患者与CeD患者的无麸质饮食依从性，并在门诊环境中评估尿液GIP检测。
这项观察性横断面研究纳入了三个成年组：（1）T1D合并CeD，（2）仅CeD，（3）仅T1D。T1D参与者从门诊诊所招募而来，CeD组通过社交媒体招募。使用定性免疫法GIP检测分析一份尿液样本（中午12点至晚上7点）。CeD参与者完成“乳糜泻饮食依从性测试”（CDAT）和“乳糜泻症状指数”（CSI）问卷。还分析了抗转谷氨酰胺酶2 IgA（IgA - TG2）和抗脱酰胺麦醇溶蛋白IgG（IgG - DGP）血清学指标。
共纳入197名参与者，平均（标准差）年龄43（15）岁。女性所占百分比分别为：CeD组90%，T1D + CeD组64%，T1D组47%。在T1D + CeD组中，15%（14/96）的参与者尿液GIP呈阳性，CeD组为0%（0/50）（P = 0.002）。正如预期的那样，仅T1D组的大多数参与者尿液GIP呈阳性（86%，44/51）。T1D + CeD组和CeD组的CDAT和CSI评分没有差异。在T1D + CeD组12%的参与者和CeD组6%的参与者中发现IgA - TG2和/或IgG - DGP水平呈阳性（P = 0.38）。
单次GIP尿液检测显示，与仅患CeD的患者相比，T1D + CeD患者的麸质暴露程度更高，这对该人群的饮食依从性提出了质疑。尿液GIP检测可用于临床随访。
