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Randomized Controlled Trial
. 2020 Jul;43(7):1553-1556.
doi: 10.2337/dc19-1944. Epub 2020 Apr 28.

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

Farid H Mahmud  1 , Antoine B M Clarke  2 , Kariym C Joachim  2 , Esther Assor  2 , Charlotte McDonald  3 , Fred Saibil  4 , Heather A Lochnan  5 , Zubin Punthakee  6 , Amish Parikh  7 , Andrew Advani  8 , Baiju R Shah  9 , Bruce A Perkins  10 , Caroline S Zuijdwijk  11 , David R Mack  12 , Dror Koltin  7 , Emilia N De Melo  2 , Eugene Hsieh  13 , Geetha Mukerji  14 , Jeremy Gilbert  9 , Kevin Bax  15 , Margaret L Lawson  11 , Maria Cino  16 , Melanie D Beaton  17 , Navaaz A Saloojee  18 , Olivia Lou  19 , Patricia H Gallego  20 , Premysl Bercik  21 , Robyn L Houlden  22 , Ronnie Aronson  23 , Susan E Kirsch  24 , William G Paterson  25 , Margaret A Marcon  26
Affiliations
Randomized Controlled Trial

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

Farid H Mahmud et al. Diabetes Care. 2020 Jul.

Abstract

Objective: To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

Research design and methods: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months.

Results: Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, N = 1,298] vs. 4.7% [95% CI 3.4-5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI -0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4-2.7; P = 0.014) emerged with a GFD.

Conclusions: CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.

Trial registration: ClinicalTrials.gov NCT01566110.

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