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World J Diabetes. Aug 15, 2013; 4(4): 130-134
Published online Aug 15, 2013. doi: 10.4239/wjd.v4.i4.130
Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control
Andrea E Scaramuzza, Cecilia Mantegazza, Alessandra Bosetti, Gian Vincenzo Zuccotti
Andrea E Scaramuzza, Cecilia Mantegazza, Alessandra Bosetti, Gian Vincenzo Zuccotti, Department of Pediatrics, Luigi Sacco Hospital, University of Milano, 20154 Milano, Italy
Author contributions: Scaramuzza AE and Mantegazza C revised the literature, drafted the paper and reviewed it; Bosetti A critically discussed all nutritional aspects of the minireview and revised it for important intellectual content; Zuccotti GV contributed to the discussion and revised the paper; all authors gave their final approval of the final version to be published.
Correspondence to: Andrea E Scaramuzza, MD, Department of Pediatrics, Luigi Sacco Hospital, University of Milano, Via G.B. Grassi 64, 20154 Milano, Italy. scaramuzza.andrea@hsacco.it
Telephone: +39-2-39042791 Fax: +39-2-39042254
Received: April 8, 2013
Revised: June 13, 2013
Accepted: July 18, 2013
Published online: August 15, 2013
Abstract

Type 1 diabetes mellitus is associated with celiac disease, with a prevalence that varies between 0.6% and 16.4%, according to different studies. After a diagnosis of celiac disease is confirmed by small bowel biopsy, patients are advised to commence a gluten-free diet (GFD). This dietary restriction may be particularly difficult for the child with diabetes, but in Europe (and in Italy) many food stores have targeted this section of the market with better labeling of products and more availability of specific GFD products. Treatment with a GFD in symptomatic patients has been shown to improve the symptoms, signs and complications of celiac disease. However, the effects of a GFD on diabetic control are less well established. Initial reports of improved hypoglycemic control were based on children who were diagnosed with celiac disease associated with malabsorption, but there have subsequently been reports of improvement in patients with type 1 diabetes with subclinical celiac disease. There are other studies reporting no effect, improved control and an improvement of hypoglycemic episodes. Moreover, in this review we wish to focus on low glycemic index foods, often suggested in people with type 1 diabetes, since they might reduce postprandial glycemic excursion and enhance long-term glycemic control. In contrast, GFD may be rich in high glycemic index foods that can increase the risk of obesity, insulin resistance and cardiovascular disease, worsening the metabolic control of the child with diabetes. Hence, it is important to evaluate the impact of a GFD on metabolic control, growth and nutritional status in children with type 1 diabetes.

Keywords: Adolescents, Celiac disease, Children, Glycemic control, Type 1 diabetes

Core tip: It is important to evaluate the impact of a gluten-free diet (GFD) on metabolic control, growth and nutritional status in children with type 1 diabetes and celiac disease. Since compliance with a strict GFD and a safe choice of food for diabetes is not easy, these patients require extra education and dietary intervention. A specialized follow-up and dietary counseling are essential in the management of patients affected by both type 1 diabetes and celiac disease.