October 26, 2016
The Journal of Pediatrics
TAKE-HOME MESSAGE
Young people with type 1 diabetes (T1D) alone were compared with those with T1D and celiac disease to examine quality of life (QoL) and glycemic control. QoL scores were similar in the two groups. However, in the group with T1D and celiac disease, diabetes-specific QoL and general well-being scores for both patients and parents were significantly lower and patient hemoglobin A1c was significantly higher in patients nonadherent to a gluten-free diet (GFD) when compared with those adherent to their GFD. QoL and hemoglobin A1c were similar in patients using continuous subcutaneous insulin infusion and patients having multiple daily injections in the combined group.
Young people with both T1D and celiac disease report better QoL and have improved glycemic control when adherent to a GFD. Adherence should be encouraged in this population.
Abstract
OBJECTIVE
To evaluate quality of life (QoL) and glycemic control in youth with type 1 diabetes (T1D) and celiac disease vs T1D only. We hypothesized that QoL scores would be lower in youth with T1D and celiac disease and those nonadherent to the gluten-free diet (GFD).
STUDY DESIGN
This case control study included 35 youth with T1D and 35 with T1D and celiac disease matched for age, sex, diabetes duration, and hemoglobin A1c level. QoL was assessed in participants and parents using the Pediatric Quality of Life Inventory Generic Core Scale, Pediatric Quality of Life Inventory Diabetes Module. and the General Well-Being Scale; youth with T1D and celiac disease also completed the celiac disease-specific DUX questionnaire and parents completed the Pediatric Quality of Life Inventory Family Impact Scale. Questionnaires were scored from 0 to 100; higher scores indicate better QoL or well-being. Scores were compared between T1D vs T1D with celiac disease, with subgroup analysis by GFD adherence vs nonadherence and therapy (continuous subcutaneous insulin infusion vs multiple daily injections).
RESULTS
Youth with T1D and celiac disease reported similar generic and diabetes-specific QoL to T1D only. GFD nonadherent vs adherent youth reported lower diabetes-specific QoL (mean score 58 vs 75, P = .003) and lower general well-being (57 vs 76, P = .02), as did their parents (50 vs 72, P = .006), and hemoglobin A1c was higher (9.6% vs 8.0%, P = .02). Youth with T1D and celiac disease using continuous subcutaneous insulin infusion vs multiple daily injections had similar generic and diabetes-specific QoL and A1C (8.6 vs 8.2%, P = .44), but were less happy having to follow a lifelong diet (59 vs 29, P = .007).
CONCLUSIONS
Youth with T1D and celiac disease who do not adhere to the GFD have lower QoL and worse glycemic control. Novel strategies are required to understand and improve adherence in those with both conditions.