Poster Presentation ESA-SRB-APEG-NZSE 2022

Introduction of a gluten-free diet in children with type 1 diabetes and newly diagnosed coeliac disease increases the glycaemic index of the diet but does not adversely impact glycaemic outcomes or quality of life (#473)

Tenele A Smith 1 2 , Alexandra L Marlow 1 2 , Jordan S Rafferty 1 2 , Prudence E Lopez 1 3 , Shaun E Johnson 4 5 , Jan Fairchild 4 5 , Sabrina K Binkowski 6 7 , Liz A Davis 6 7 8 , Bruce R King 1 2 3 , Carmel E Smart 1 2 3
  1. College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
  2. Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  3. Department of Endocrinology, John Hunter Children’s Hospital, New Lambton Heights, NSW, Australia
  4. Department of Endocrinology and Diabetes, Women’s and Children’s Hospital, Adelaide, SA, Australia
  5. Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, SA, Australia
  6. Telethon Kids Institute, Children’s Diabetes Centre, University of Western Australia, Perth, WA, Australia
  7. Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
  8. Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA, Australia

AIM

To evaluate the impact of a gluten-free diet (GFD) on BMI, glycaemic outcomes, nutrient intake, and quality of life (QoL) in children (2-18 years) with type 1 diabetes (T1D) and newly diagnosed coeliac disease (CD).

METHODS

This was a prospective cohort trial conducted at three Australian paediatric T1D centres. Prior to CD diagnosis, baseline height, weight, HbA1c, 14-days of continuous glucose data; and a 4-day food diary were collected. Participant and parent QoL were measured using the PedsQL. On diagnosis, participants received standardised GFD education. Baseline measures were repeated at 3-months. Dietary adherence was assessed using the gluten-free compliance questionnaire.

RESULTS

Participants (n=20) had a mean age of 8.2±3.6 years and diabetes duration of 1.4±1.9 years, 19/20 were assessed as adherent to the GFD. Compared to baseline, at 3-months post-GFD there were no significant differences in BMI Z-score (0.59 vs 0.58, p=0.893), glycaemic outcomes including HbA1c (53.6mmol/mol vs 53.8mmol/mol, p=0.944); TIR, 3.9-10.0 mmol/L (65% vs 62%, p=0.236); TAR, >10.0 mmol/L (29% vs 31%, p=0.413); TBR, <3.9 mmol/L (6.6% vs 6.9%, p=0.720) and daily intake of carbohydrate (206 vs 197g, p=0.435), fat (56g vs 69g, p=0.475), saturated fat (25g vs 26g, p=0.624) and protein (62g vs 60g, p=0.607). Post-GFD there was a significant decrease in the daily intake of iron (8.8mg vs 6.9mg, p=0.020), folate (618ug vs 389ug, p=0.007) and magnesium (223mg vs 188mg, p=0.028) and a significant increase in the glycaemic index of the diet (55 vs 58, p<0.001). QoL of the participants (59 vs 63, p=0.300) and parents (63 vs 68, p=0.135) was unchanged.

CONCLUSIONS

In children with T1D and newly diagnosed CD, introduction of a GFD does not impact QoL or glycaemic outcomes at 3-months post-diagnosis despite the glycaemic index of the diet being higher. Intensive dietary review is needed to ensure diet quality is maintained.