Hegab Ahmed Monir, Abou-Taleb Ashraf
Pediatrics Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
Pediatr Diabetes. 2025 Jul 4;2025:1283259. doi: 10.1155/pedi/1283259. eCollection 2025.
Assessment of celiac disease and gluten-free diet (GFD) associations with metabolic control and growth parameters in children and adolescents with type 1 diabetes mellitus (T1DM) during the first year after diagnosis of celiac disease. This was a retrospective case-control study that included 47 children and adolescents with T1DM aged <18 years who attended the pediatric diabetes clinic at Sohag University Hospital, Egypt, and had a biopsy-proven diagnosis of celiac disease between January 2017 and December 2021. Each case had two age-, sex-, and duration of diabetes-matched control participants with T1DM who had persistently negative celiac screening tests. Clinical characteristics, growth parameters, insulin doses, celiac autoantibody titers, and HbA1c levels throughout the first year after diagnosis of celiac disease were obtained from the medical records. Children and adolescents with celiac disease had significantly lower insulin doses at diagnosis (=0.002) compared to their matched controls. There were no significant differences between both groups regarding the HbA1c levels at diagnosis of celiac disease or after 1 year (=0.27 and 0.81, respectively). Patients with celiac disease had significantly lower weight, height, and body mass index (BMI) standard deviation scores (SDSs) at diagnosis and after 1 year. There were no significant differences between both groups regarding the fasting lipid profiles at diagnosis or after 1 year. Patients with villous atrophy at diagnosis had significantly higher HbA1c levels after 1 year (=0.04). There were no significant improvements in weight, height, and BMI SDS after 1 year even in patients with normalized celiac autoantibodies. Children and adolescents with T1DM had lower insulin requirements and growth parameters at diagnosis of celiac disease. Villous atrophy at diagnostic small bowel biopsies was associated with worsening glycemic control after 1 year. Longer follow-up periods are required to detect significant improvements in growth parameters.
乳糜泻诊断后第一年，评估1型糖尿病（T1DM）儿童和青少年中乳糜泻及无麸质饮食（GFD）与代谢控制和生长参数的关联。这是一项回顾性病例对照研究，纳入了47名年龄小于18岁的T1DM儿童和青少年，他们在2017年1月至2021年12月期间在埃及索哈杰大学医院儿科糖尿病门诊就诊，并经活检证实患有乳糜泻。每个病例有两名年龄、性别和糖尿病病程匹配的T1DM对照参与者，其乳糜泻筛查试验持续为阴性。从病历中获取乳糜泻诊断后第一年的临床特征、生长参数、胰岛素剂量、乳糜泻自身抗体滴度和糖化血红蛋白（HbA1c）水平。与匹配的对照组相比，患有乳糜泻的儿童和青少年在诊断时胰岛素剂量显著更低（=0.002）。两组在乳糜泻诊断时或1年后的HbA1c水平无显著差异（分别为=0.27和0.81）。患有乳糜泻的患者在诊断时和1年后体重、身高和体重指数（BMI）标准差评分（SDS）显著更低。两组在诊断时或1年后的空腹血脂谱无显著差异。诊断时存在绒毛萎缩的患者1年后HbA1c水平显著更高（=0.04）。即使乳糜泻自身抗体恢复正常的患者，1年后体重、身高和BMI SDS也无显著改善。患有T1DM的儿童和青少年在乳糜泻诊断时胰岛素需求和生长参数更低。诊断性小肠活检时的绒毛萎缩与1年后血糖控制恶化有关。需要更长的随访期来检测生长参数的显著改善。
