Cumulative incidence of type 1 diabetes in two cohorts of children with different national gluten recommendations in infancy

Aims: Between 1985 and 1996, Sweden experienced an “epidemic” of celiac disease with a fourfold increase in incidence in young children. Timing and amount of gluten introduced during infancy have been thought to explain this “epidemic”. We aimed to study whether the cumulative incidence of type 1 diabetes differs between children born during the “epidemic” compared to children born after. Methods: This is a national register study in Sweden comparing the cumulative incidence of type 1 diabetes in two birth cohorts of 240 844 children 0–17 years old born 1992–1993, during the “epidemic”, and 179 530 children born 1997–1998, after the “epidemic”. Children diagnosed with type 1 diabetes were identified using three national registers. Results: The cumulative incidence of type 1 diabetes by the age of 17 was statistically significantly higher in those born after the “epidemic” 0.77% than in those born during the “epidemic” 0.68% (p < 0.001). Conclusion: The incidence of type 1 diabetes is higher in those born after the epidemic compared to those born during the epidemic, which does not support the hypothesis that gluten introduction increases the incidence of T1D. Changes in gluten introduction did not halt the increased incidence of type 1 diabetes in Sweden.