The Experience of a Gluten-free Diet in Children with Type 1 Diabetes and Celiac Disease

Abstract

Objective This study examined overall self-reported adherence to gluten-free diet (GFD) in children with type 1 diabetes and celiac disease (T1DCD) compared to children with celiac disease (CD). Secondary objectives included gaining insight into self-reported symptoms, barriers to adherence, and experience of a GFD between groups. Methods Children <18 years old who had been seen at BC Children’s Hospital for T1DCD or CD were invited to participate in a web-based questionnaire and medical record review. Results A total of 26 children with T1DCD and 46 children with CD participated in the study. The groups’ demographics and symptoms of CD were similar; however, a greater proportion of those with T1DCD were asymptomatic at diagnosis (T1DCD 27%; CD 7%; P = 0.016). Overall adherence to a GFD was high in both groups (T1DCD 92%; CD 100%; P = 0.38) but those with T1DCD reported a significantly less positive effect on their health (P = 0.006) and a significantly greater negative effect on activities from a GFD (P = 0.03). Children with T1DCD reported more significant barriers to eating gluten-free at home and at restaurants, specifically with social pressure, cost and taste compared to those with CD only. Conclusion Children with T1DCD face specific barriers in adherence that are more impactful compared with children living with CD. These children are more often asymptomatic at diagnosis, and they go on to experience different impacts of a GFD spanning across home and social settings. Given the complexity of having a dual diagnosis, CD care should be tailored specifically to children living with T1DCD.

Coexisting Type 1 Diabetes, Persistent Symptoms, and Financial Issues Associate With Poorer Adherence to a Gluten-Free Diet in Celiac Disease After Transition From Pediatrics to Adult Care

“…It is logical that the co-existence of two chronic conditions requiring continuous monitoring and care would increase the risk for non-adherence. However, these challenges may not emerge before responsibility for treatment shifts from caregivers to patients themselves in adolescence ( 33 , 40 ), although here the difference was seen already during childhood follow-up. Also, availability and price of gluten-free products seemed to play especially significant role for those with coexistent T1D.…”