2020年 · 第100卷第38期

As a common chronic airway disease, bronchial asthma (hereinafter referred to as asthma) not only seriously affects the physical and mental health of patients, but also brings a heavy mental and economic burden to families and society. Affected by the accelerated industrialization and urbanization, environmental pollution and changes in climate and ecological environment, the incidence and prevalence of asthma is increasing. It is estimated that there are about 300 million asthma patients worldwide^[1]。

Writing Team Leader

Compared with the general population, patients with type 1 diabetes (T1DM) have an increased risk of developing celiac disease. According to previous literature reports, 1% to 16% of T1DM patients are complicated with celiac disease, but these patients often have no typical clinical manifestations of celiac disease such as diarrhea and abdominal distension, but are diagnosed by screening for serum antibodies and endoscopy. At present, it is inconclusive whether patients with T1DM complicated with subclinical celiac disease need to be treated with a de-gelatin diet (GFD). This study evaluated the effects of GFD on hypoglycemic episodes and height, weight, glycosylated hemoglobin (HbA1c), insulin dosage, bone metabolism and other indicators in patients with T1DM complicated with subclinical celiac disease through a prospective randomized controlled trial (RCT). The study screened for celiac disease in 320 patients with T1DM. The diagnostic criteria for celiac disease were positive for anti-tissue glutaminase antibody immunoglobulin A (tTG-IgA) and duodenal biopsy consistent with celiac histopathological changes, or normal biopsy pathology but tTG-IgA>200 U/ml. Subclinical celiac disease was defined as meeting the above diagnostic criteria for celiac disease and without chronic diarrhea, recurrent diarrhea, severe anemia (hemoglobin<80 g/L). The study finally included 30 subclinical celiac patients who were randomly divided into GFD and non-GFD groups. The patients in the two groups were evaluated at the 6th month of dietary intervention. The differences in the number of hypoglycemic episodes (2.3 vs. 3.4, P =0.5) and the mean onset time (124.1 min vs. 356.9 min, P =0.1) between the GFD and non-GFD groups were not statistically significant; However, the number of hypoglycemic episodes in the 6th month of GFD group was significantly reduced compared with baseline (2.3 vs. 3.5, P =0.03); HbA1c decreased by 0.73% in the GFD group and increased by 0.99% in the non-GFD group; There were no significant differences in height, weight, insulin dosage and bone metabolism indexes between the two groups. This study suggests that GFD may be beneficial to blood glucose control and reduce the occurrence of hypoglycemic events in patients with T1DM complicated with celiac disease. The definite role of GFD still needs to be further verified by RCT on a larger scale and longer follow-up time.