Case Report

Elimination of Dietary Gluten and Development of Type 1 Diabetes in High Risk Subjects

Martin Füchtenbusch, Anette-G. Ziegler, Michael Hummel

Keywords: type 1 diabetes, celiac disease, islet antibody, autoantibody, gluten-free diet

Abstract

Removal of dietary gluten is associated with a lower frequency of type 1 diabetes (T1D) in patients with celiac disease. Therefore, we performed a pilot study in which seven islet-antibody-positive first degree relatives of patients with T1D were placed on a gluten-free diet for 12 months, followed by gluten re-exposure for 12 months, to investigate whether this could reduce levels of circulating autoantibodies. We found that islet autoantibody levels at the end of the gluten-free period were not different to those before the commencement of the diet nor to antibody levels at the end of the gluten re-exposure period. In the present study, we have followed the 7 children formerly placed on a gluten-free diet for the manifestation of T1D for up to 5 years (mean follow-up time after fulfilling inclusion criteria: 4.8 years, SE 0.82 years) and compared them to 30 siblings and offspring of patients with T1D with similar characteristics to the intervention group (mean follow-up time: 5 years, SE 0.62 years). The cumulative 5-year risk of T1D in the intervention group did not differ from that in the prediabetic control group (42.9%, 95 CI (6.3-79.5%) vs. 49.7%, 95 CI (30.9-68.5%), p=0.87, log-rank test). These findings suggest that removing gluten from the diet over a period of one year is effective neither in the short nor in the long term in high-risk prediabetic individuals with a fully activated immune response to different islet antigens close to manifestation of T1D. These and recent data showing that exposure to dietary gluten in offspring of mothers and fathers with T1D very early in life is associated with an increased risk of developing islet antibodies also suggest that removal of dietary gluten should be tested as early as possible in children with an increased risk of islet autoimunity, i.e. before an immune response to islet antigens is established.

Fulltext: HTML , PDF (171KB)

This article has been cited by other articles:

	What causes type 1 diabetes? Lessons from animal models Buschard K APMIS Suppl 2011. 119(Suppl 132):1-19
	Early determinants of type 1 diabetes: experience from the BABYDIAB and BABYDIET studies Hummel S, Ziegler AG Am J Clin Nutr 2011. In press
	Shared genetics in coeliac disease and other immune-mediated diseases Gutierrez-Achury J, Coutinho de Almeida R, Wijmenga C J Intern Med 2011. 269(6):591-603
	Intestinal immune regulation as a potential diet-modifiable feature of gut inflammation and autoimmunity Sonier B, Patrick C, Ajjikuttira P, Scott FW Int Rev Immunol 2009. 28(6):414-445
	Celiac sprue: a unique autoimmune disorder Rashtak S, Marietta EV, Murray JA Expert Rev Clin Immunol 2009. 5(5):593-604
	Tissue Transglutaminase Antibodies in Individuals with Celiac Disease Bind to Thyroid Follicles and Extracellular Matrix and May Contribute to Thyroid Dysfunction Naiyer AJ, Shah J, Hernandez L, Kim SY, Ciaccio EJ, Cheng J, Manavalan S, Bhagat G, Green PH Thyroid 2008. 18(11):1171-1178
	Type 1 diabetes mellitus: primary, secondary, and tertiary prevention Bollyky J, Sanda S, Greenbaum CJ Mt Sinai J Med 2008. 75(4):385-397
	A unifying hypothesis on the development of type 1 diabetes and celiac disease: gluten consumption may be a shared causative factor Frisk G, Hansson T, Dahlbom I, Tuvemo T Med Hypotheses 2008. 70(6):1207-1209
	Cereal exposures in the infant diet and risk of diabetes autoimmunity in children Norris JM Immunol Endocr Metabol Agent Med Chem 2007. 7(3):219-229
	Gluten and Disorders of the Immune System Müller DB, Hummel S, Ziegler AG, Hummel M Akt Ernähr Med 2007. 32:117-124