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| Name | Class |
|---|---|
| Juvenile Diabetes Research Foundation | OTHER |
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To evaluate the effect of Gluten Free Diet (GFD) on beta-cell function and glucose metabolism in subjects with one or several islet autoantibodies without and with dysglycemia at baseline. Additionally, all subjects will be given treatment with Vitamin D, omega fatty acids and probiotics.
Subjects will be randomized to GFD or normal diet during 18 months. Beta cell function will be evaluated at baseline, and during follow-up by glucose tolerance tests.
The design is a randomized controlled study to determine the safety and the effect of gluten free diet during 18 months on beta-cell function and glucose metabolism. Lead-in and nonstop supplement cocktail including vitamin D, omega fatty acids and probiotics will be used to equalize differences to reduce known confounders. All study subjects will meet with a dietician to obtain a 3-day diet record and to receive instructions on a healthy normal diet or GFD.
Subjects (n=60) at 2-49.99 years of age positive for one or several islet autoantibodies will be recruited. Subjects with one islet autoantibody have done one or several oral glucose tolerance test (OGTT) prior to the baseline visit. One islet autoantibody positive subjects are only eligible if they have dysglycemia. All subjects will be randomized based on baseline intravenous glucose tolerance test (IvGTT) and OGTT into subjects without and with dysglycemia at baseline.
Beta-cell function and glucose metabolism (alternating IvGTT and OGTT) will be assessed at baseline and after 6, 12, 18 months of treatment and after 6 months of wash out on a normal healthy diet.
Adverse events and safety Adverse event will be obtained at visits and during the study, which will be monitored.
It is expected that subjects with one or several islet autoantibodies will show a loss compared to baseline of beta-cell function and glucose control. GFD is expected to reduce the loss in subjects on a healthy diet.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Gluten free diet | Experimental | Gluten free diet during 18 months. The subjects will be referred to a nutritionist every 6 months. Vitamin D 800 U Daily, Omega 3 fatty acids and probiotics as nutritional supplements. |
|
| Normal diet | Active Comparator | Normal diet. Vitamin D 800 U Daily, Omega 3 fatty acids and probiotics as nutritional supplements. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Gluten free diet | Dietary Supplement | Gluten free diet during 18 months. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change in first phase insulin response (FPIR) from IvGTT | Change in First phase insulin response from IvGTT during follow-up | 24 months |
| Change in area under the curve (AUC) C-peptide | Change in AUC C-peptide from OGTT during follow-up | 24 months |
| Change in glucose metabolism | Change from normal to impaired glucose metabolism during follow-up | 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Treatment-Emergent Adverse Events | To evaluate safety of GFD compared to recommended normal diet in the placebo group in subjects supplemented with lead in and nonstop treatment with a cocktail including vitamin D, omega fatty acids and probiotics. | 24 months |
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Inclusion Criteria:
Exclusion Criteria:
Ongoing treatment with immunosuppressant therapy (topical or inhaled steroids are accepted).
Diabetes.
Treatment with any oral or injected anti-diabetic medications.
Significantly abnormal hematology results at screening.
Participation in other clinical trials with a new chemical entity within the previous 3 months.
History of hypercalcemia.
Presence of associated serious disease or condition.
Diabetes-protective HLA-DQ6-allele.
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| Name | Affiliation | Role |
|---|---|---|
| Maria MÃ¥nsson Martinez, Nutricionist | Lund University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lund University, Department of Clinical Sciences Malmö | Malmö | 20502 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34983671 | Derived | Martinez MM, Spiliopoulos L, Salami F, Agardh D, Toppari J, Lernmark A, Kero J, Veijola R, Tossavainen P, Palmu S, Lundgren M, Borg H, Katsarou A, Larsson HE, Knip M, Maziarz M, Torn C; and the TEDDY-Family (TEFA) Study Group. Heterogeneity of beta-cell function in subjects with multiple islet autoantibodies in the TEDDY family prevention study - TEFA. Clin Diabetes Endocrinol. 2022 Jan 5;7(1):23. doi: 10.1186/s40842-021-00135-6. | |
| 33855205 |
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| ID | Term |
|---|---|
| D011236 | Prediabetic State |
| D003922 | Diabetes Mellitus, Type 1 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| D055050 | Diet, Gluten-Free |
| D015525 | Fatty Acids, Omega-3 |
| D014807 | Vitamin D |
| D019936 | Probiotics |
| ID | Term |
|---|---|
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
| D004032 | Diet |
| D009747 |
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| Omega 3 fatty acid |
| Dietary Supplement |
Omega 3 fatty acid |
|
| Vitamin D | Dietary Supplement | Vitamin D 800 U/day |
|
| Probiotics | Dietary Supplement | Probiotics |
|
| Derived |
| Martinez MM, Salami F, Larsson HE, Toppari J, Lernmark A, Kero J, Veijola R, Koskenniemi JJ, Tossavainen P, Lundgren M, Borg H, Katsarou A, Maziarz M, Torn C; TEDDY Family (TEFA) Study Group. Beta cell function in participants with single or multiple islet autoantibodies at baseline in the TEDDY Family Prevention Study: TEFA. Endocrinol Diabetes Metab. 2020 Nov 5;4(2):e00198. doi: 10.1002/edm2.198. eCollection 2021 Apr. |
| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D004042 | Dietary Fats, Unsaturated |
| D004041 | Dietary Fats |
| D005223 | Fats |
| D008055 | Lipids |
| D005231 | Fatty Acids, Unsaturated |
| D005227 | Fatty Acids |
| D005395 | Fish Oils |
| D009821 | Oils |
| D012632 | Secosteroids |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D019587 | Dietary Supplements |
| D005502 | Food |
| D019602 | Food and Beverages |