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dc.contributor.authorPham-Short, Ann Nguyen Thuy Linh
dc.date.accessioned2019-08-08
dc.date.available2019-08-08
dc.date.issued2018-12-31
dc.identifier.urihttp://hdl.handle.net/2123/20864
dc.descriptionIncludes publicationsen_AU
dc.description.abstractCoeliac disease (CD) coexists with type 1 diabetes (T1D) substantially more than in the general population. This body of work examines the broad and pervasive relationship between CD on T1D, including the epidemiology, screening practices, microvascular complications, quality of life (QoL), nutrition, glycaemic variability, and bone health. In particular, the contribution of gluten free diet (GFD) adherence is explored. Study 1: The 20-year incidence of CD in 4,379 people with T1D aged <18 years was 7.7 per 1000 person years. Incidence was significantly higher in those with T1D onset < age 5 years, but this subgroup developed CD after significantly longer T1D duration than those with T1D onset >5 years. Study 2: We systematically reviewed the epidemiology of CD in 11,157 youth with T1D alone and 587 with coexisting CD; 55% of CD cases were diagnosed within 2 years of T1D and 79% within 5 years. We concluded that CD screening should be performed at T1D diagnosis and repeated within 5 years of T1D. Study 3: Comparing 129 youth with T1D and CD vs 2,510 with T1D alone, retinopathy, albumin excretion rate (AER) and neuropathy did not differ. HbA1c was lower in those with CD (8.3% vs 8.6%, p=0.04), however elevated AER was more prevalent in those who did not adhere to the GFD (40% vs 23%, p=0.04). Study 4: In a case control study of 35 youth with T1D and 35 with coexisting CD, and their carers, generic and diabetes-specific QoL did not differ. Youth using insulin pumps had similar generic and diabetes specific QoL to those using multiple daily injections. However, those who did not adhere to the GFD had lower diabetes specific QoL and lower general wellbeing, as did their carers. Study 5: In a case control study using continuous glucose monitoring, youth with T1D and CD had greater glycaemic variability, with a shorter time to peak blood glucose levels (BGL), higher peak, and higher postprandial BGLs than T1D alone, despite similar pre-meal BGLs. Both groups had inadequate calcium, folate and fibre, with excessive saturated fat and sodium intake. Study 6: In a case control study utilising dual energy x-ray absorptiometry and peripheral quantitative computational tomography, youth with coexisting T1D and CD had lower bone mineral content, abnormal trabecular and cortical bone development, and a lower bone turnover state with reduced muscle pull vs T1D alone. These studies further our understanding of the impact of coexisting CD in T1D. The findings inform screening and management of CD, and provide evidence in support of GFD adherence to optimise clinical, dietary, and psychosocial management.en_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectdiabetesen_AU
dc.subjectnutrionen_AU
dc.subjecthealthen_AU
dc.subjectpaediatricsen_AU
dc.subjectcoeliac diseaseen_AU
dc.titleThe Impact of Coexisting Coeliac Disease on Type 1 Diabetesen_AU
dc.typeThesisen_AU
dc.type.thesisDoctor of Philosophyen_AU
usyd.facultyFaculty of Medicine and Health, Children's Hospital Westmead Clinical Schoolen_AU
usyd.degreeDoctor of Philosophy Ph.D.en_AU
usyd.awardinginstThe University of Sydneyen_AU


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