Screening And Treatment Outcomes In Adults And Children With Type 1 Diabetes And Asymptomatic Celiac Disease: The Cd-Diet Study

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 HbA(1c)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 HbA(1c)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.