Gluten-sensitive enteropathy in patients with insulin-dependent diabetes mellitus.
OBJECTIVE
To determine the prevalence of celiac disease in a cohort of patients with insulin-dependent diabetes mellitus and to describe the clinical characteristics of patients with coexistent disease.


METHODS
Prospective cohort study.


METHODS
U.S. Army medical center.


METHODS
47 patients with insulin-dependent diabetes mellitus.


METHODS
Antiendomysial antibody testing was used to screen for celiac disease. The diagnosis of celiac disease required histologic evidence of villous atrophy and crypt hyperplasia and a positive antiendomysial antibody test result. In patients identified as having coexistent disease, complete blood counts, multiphasic biochemical testing, D-xylose absorption testing, and bone mineral density estimates were done.


RESULTS
3 of 47 patients with insulin-dependent diabetes mellitus (6.4%; 95% CI, 1.4% to 17.5%) had positive antiendomysial antibody test results and small-bowel biopsy specimens consistent with celiac disease. The 95% CI lies entirely above the estimated prevalence of celiac disease expected in the general U.S. population, which ranges from 0.02% to 0.1%. Mean bone mineral densities were 0.8 and 1.1 SD below age-, ethnicity-, and sex-matched controls in each of the 2 antiendomysial antibody-positive patients tested. Small bowel absorption was abnormal in 1 of the 2 patients tested by D-xylose. Anemia and hypoalbuminemia were not detected in any of the patients with coexistent disease. Only 1 of the 3 patients had symptoms of diarrhea. All patients were at or above their ideal body weights.


CONCLUSIONS
Celiac disease appears to be more common among patients with insulin-dependent diabetes mellitus than in the general U.S. population (p less than 0.001). Two of the three patients with coexistent disease in this study had subclinical or latent celiac disease.
Rensch
M J
MJ
Fitzsimons Army Medical Center, Aurora, Colorado, USA.
Merenich
J A
JA
Lieberman
M
M
Long
B D
BD
Davis
D R
DR
McNally
P R
PR
D000328:Adult; D001284:Atrophy; D001323:Autoantibodies / Q000032:analysis; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009210:Myofibrils / Q000276:immunology; D011446:Prospective Studies
D001323:Autoantibodies