Should Practitioners Recommend Gluten-Free Diets for Patients with Type 1 Diabetes Who Are at Risk for Celiac Disease?

Patients with type 1 diabetes (T1D) are at a substantially increased risk for developing Celiac disease (CD). A study that is currently underway, outlined in BMC Gastroenterology, will examine whether educational efforts for those at risk of developing CD can significantly decrease the chances of diabetes patients contracting CD.

Celiac Disease (CD) is known to be triggered by gluten ingestion from wheat, rye and barley and their derivatives in genetically susceptible individuals, and its only treatment is lifelong adherence to a gluten-free diet (GFD). The challenge for practitioners is that many T1D patients at risk for CD tend to be asymptomatic. “Evidence is inconclusive as to whether the benefits of screening and potentially treating asymptomatic individuals outweigh the harms of managing a population already burdened with an established chronic illness,” the study authors note.

The current trial, dubbed the CD-DIET Study (Celiac Disease and Diabetes - Dietary Intervention and Evaluation Trial), is a multicenter, randomized, controlled trial that will look at the effectiveness of a GFD on diabetes control (HbA1c), bone health, blood glucose variability, and patient centered measures, including quality of life and self-perceived health. Dietary outcomes will include description and evaluation of food consumption patterns including glycemic index and load, dietary characteristics including gluten quantification, and highlight objective and subjective measures of GFD adherence.

The researchers hope that the trial will establish rigorous guidelines to assess adherence and facilitate evaluation of a GFD on metabolic control, bone health and patient quality of life in patients with CD and diabetes.

Patients (ages 8—45) will be randomly assigned to a GFD or continue with their usual diabetes gluten containing meal plan. Patients will be followed-up every 3 months.

“While the literature supports the implementation of a GFD in symptomatic CD and T1D patients, it is less clear as to the benefits for asymptomatic patients,” the researchers explained. “Our curriculum was established in concurrence with the current literature and is designed to address a number of issues: the limited educational literature the challenges associated with dietary quality and adherence and the implicated social challenges of a GF lifestyle in addition to T1D...This study will answer some of the questions with regards to perceived benefits of GFD, especially when almost a third of health practitioners are unsure whether they should be recommending GFD to asymptomatic patients.”

A first round of results from the study, currently active at 16 Canadian health centers, will be available in 2016.