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We agree that beneficial effect of gluten free diet (GFD) on glycaemic control in T1DM with celiac disease is not yet supported by large randomized studies. However, a small study by Amin et al1 documented that switching to GFD improved body mass index and HbA1C in patients with T1DM with celiac disease. To reach a meaningful conclusion on this issue results from large longitudinal studies are needed.
We agree that screening of celiac disease in T1DM individuals is most productive till 10 years of age2. However, we feel that screening should be continued in later life also if symptoms or signs are not explained by T1DM alone. It is known that elevated tissue transglutaminase IgA antibodies are spontaneously normalized in some patients3, so diagnosis of celiac disease should be made in conjunction with intestinal mucosal biopsy suggestive of celiac disease with elevated tissue transglutaminase IgA antibodies4. It will help to prevent from prescribing GFD to individuals with T1DM, and those already on significant dietary restrictions. In our study celiac disease was diagnosed as per European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHN) criteria4.
References
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