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Gluten-free diet delays insulin dose increase in T1D

Elaine Soliven
18 Sep 2017

A gluten-free diet (GFD) may help delay the increase of insulin dose in children with newly diagnosed type 1 diabetes (T1D), according to a study presented at EASD 2017.

The researchers retrospectively analysed the changes in insulin dose in 46 children diagnosed with T1D (mean age at diagnosis, 6.9 years), 42 of whom also had coeliac disease (CD) and were on a GFD. Participants were divided into two groups: GFD+ (n=27; started GFD before or since the diagnosis of T1D) and GFD- (n=19; started GFD few years after the diagnosis of T1D or those not keeping GFD). Patients were followed up for up to 3 years. [EASD 2017, abstract 1215]

At 1-year follow-up, a significant increase in insulin dose was observed in the GFD- group compared with the GFD+ group (0.64 vs 0.43 IU/kg; p<0.01). At 1.5-years follow-up, children in the GFD- group still had higher insulin dose than those in the GFD+ group (0.7 vs 0.5 IU/kg; p<0.01).

A significant increase in insulin dose was only noted in the GFD+ group after 2 years of follow-up.

Overall, both groups showed a similar increase in insulin dose at 3 years, from 0.40 to 0.72 IU/kg in the GFD- group (p<0.001) and from 0.41 to 0.71 IU/kg in the GFD+ group (p<0.001).

“During the remission phase, the increase in insulin requirement reflects the evolution of endogenous insulin reserve. GFD, therefore, likely helps to conserve endogenous insulin … The prolongation of the remission phase is of clinical significance in view of the long-term metabolic control,” according to lead author Dr Peter Toth-Heyn from the First Department of Pediatrics at Semmelweis University in Budapest, Hungary.

“These are the first clinical data confirming the possible pathogenetic role of gluten in the progression of T1D,” said Toth-Heyn. “[However,] there is not enough clinical evidence to prove a role for GFD in T1D prevention.”
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