PREBIABETIC INDICES IN CHILDREN WITH GLUTEN SENSITIVITY ENTEROPATHY. (GSE)

Abstract

This is a prospective study of insulin secretion and immunologic changes in a group of children with GSE on gluten free diet. The purpose of the study is to investigate the possible association of disturbances of insulin secretion with the incidence of insulin dependent diabetes mellitus (IDDM) which is known to be high in GSE. Thirty patients, 4 to 18 years old, were examined. They underwent IV glucose tolerance test during which glucose disappearance rate (K) and first phase insulin response (It'+3') were measured. Typing for HLA A, B, C and DR antigens was performed and sera were analysed for cytoplasmic islet cell antibodies (ICA) on two occasions. Pancreatic isoamylase (PIA) was measured as an index of exocrine pancreatic function. The same procedures were performed on 30 healthy children. The results are as ollows: a) In 24% of celiac children It'+3' and K rate were decreased, b) There was significant correlation between the two parameters (p<0,01). c)The incidence of HLA B₃ and DR₃ was higher in GSE (33% and 60%, respectively) than in healthy individuals (6,6% and 20%, respectively). d) All patients were found to be ICA negative at the time of the study. e) There was no correlation between parameters of endocrine (It'+3', K rate) and exocrine pancreatic function (PIA).

Conclusions: Although there was no evidence of islet cell immune destruction at the time of the study, a decline of first phase insulin secretion was indeed documented. This decline may be an expression of a prediabetic phase. HLA B₃, and DR₃ which are detected in celiac patients may indicate a possible common pathogenetic mechanism between GSE and IDDM.

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