Gluten-Free Diet in Subjects at Risk for Type 1 Diabetes: A Tool for Delaying Progression to Clinical Disease?

The study has now been extended to 22 first degree relatives positive for two or more antibodies among anti-GAD (GADA), anti-IA-2 (IA2A) and anti-insulin (IAA) undergoing a total of 27 six-month periods of a gluten-free diet, followed by an equal number of six-month periods of normal gluten-containing diet. Five subjects developed clinical diabetes during follow-up. In the remainder, first phase insulin response (FPIR) to i.v. glucose tolerance test after the first 6 months of gluten deprivation increased in 19 of the 25 periods tested (P = 0.021 of 6 m vs baseline); 6months after return to normal diet, FPIR decreased in 17 of 20 period tested (P = 0.005 of 12 vs 6 m). Patients were stratified as high responders (1st tertile), low responders (2nd tertile) and non responders (3rd tertile) according to FPIR after gluten deprivation and several immunological and metabolic markers have been evaluated for their possible predictive value of response to gluten deprivation.