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Open Access Highly Accessed Research article

Nutritional status, growth and disease management in children with single and dual diagnosis of type 1 diabetes mellitus and coeliac disease

Mary Mackinder1, Gavin Allison2, Vaios Svolos1, Elaine Buchanan3, Alison Johnston2, Tracey Cardigan3, Nicola Laird3, Hazel Duncan3, Karen Fraser3, Christine A Edwards1, Ian Craigie2, Paraic McGrogan13 and Konstantinos Gerasimidis1*

Author Affiliations

1 Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, Royal Hospital for Sick Children, University of Glasgow, G3 8SJ Glasgow, UK

2 Department of Paediatric Diabetes, Royal Hospital for Sick Children, Glasgow, G3 8SJ Glasgow, UK

3 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, G3 8SJ Glasgow, UK

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BMC Gastroenterology 2014, 14:99  doi:10.1186/1471-230X-14-99

Published: 28 May 2014

Abstract

Background

The consequences of subclinical coeliac disease (CD) in Type 1 diabetes mellitus (T1DM) remain unclear. We looked at growth, anthropometry and disease management in children with dual diagnosis (T1DM + CD) before and after CD diagnosis.

Methods

Anthropometry, glycated haemoglobin (HbA1c) and IgA tissue transglutaminase (tTg) were collected prior to, and following CD diagnosis in 23 children with T1DM + CD. This group was matched for demographics, T1DM duration, age at CD diagnosis and at T1DM onset with 23 CD and 44 T1DM controls.

Results

No differences in growth or anthropometry were found between children with T1DM + CD and controls at any time point. Children with T1DM + CD, had higher BMI z-score two years prior to, than at CD diagnosis (p < 0.001). BMI z-score change one year prior to CD diagnosis was lower in the T1DM + CD than the T1DM group (p = 0.009). At two years, height velocity and change in BMI z-scores were similar in all groups. No differences were observed in HbA1c between the T1DM + CD and T1DM groups before or after CD diagnosis. More children with T1DM + CD had raised tTg levels one year after CD diagnosis than CD controls (CDx to CDx + 1 yr; T1DM + CD: 100% to 71%, p = 0.180 and CD: 100% to 45%, p < 0.001); by two years there was no difference.

Conclusions

No major nutrition or growth deficits were observed in children with T1DM + CD. CD diagnosis does not impact on T1DM glycaemic control. CD specific serology was comparable to children with single CD, but those with dual diagnosis may need more time to adjust to gluten free diet.

Keywords:
Coeliac; Diabetes; Glycaemic control; Growth; Nutrition