Coeliac disease, gluten-free diet and the development and progression of albuminuria in children with type 1 diabetes

Objectives: Although a diagnosis of coeliac disease (CD) may be confronting to children with type 1 diabetes and their families, we hypothesize that children with CD have lower urinary albumin excretion, a marker of renal dysfunction. Research design: Twenty-four children with type 1 diabetes and biopsy-proven CD, on a gluten-free diet for at least 1yr, were recruited from a single paediatric diabetes clinic alongside 55 children with type 1 diabetes but without CD matched for age, gender, duration of diabetes, and glycaemic control. Results: Despite comparable diabetes exposure, glycaemic control and nutritional status, children with type 1 diabetes and CD had a lower urinary albumin creatinine ratio than in diabetic subjects without CD (0.9 +/- 0.3mg/mmol vs. 1.6 +/- 0.3mg/mmol; p=0.01). Participants with CD also showed slower progression in albuminuria over 5-yr of follow-up while a small but significant increase was observed in the children with diabetes alone (1.6 +/- 0.3mg/mmol; follow-up 2.4 +/- 0.5mg/mmol; p=0.02). Conclusions: As urinary albumin excretion is continuously associated with the risk of kidney disease, it is possible to speculate that CD or its management confers a degree of renoprotection. Larger studies are required to test this hypothesis.