title: Screening for coeliac disease in adult insulin-dependent diabetes mellitus.
abstract: OBJECTIVE
  To study, by sequential screening for gliadin antibodies (GA) and endomysial antibodies (EMA), the prevalence and clinical characteristics of coeliac disease (CD) in adult IDDM patients.
  
  
  METHODS
  A series comprising 1664 diabetes patients [848 with IDDM, 745 with non-insulin-dependent diabetes (NIDDM) and 71 with secondary diabetes] were screened for GA. IgA- or IgG-GA positive sera were analysed for EMA.
  
  
  RESULTS
  IgA-GA were more frequent in all the diabetes subgroups (13.7% in IDDM,12.3% in NIDDM and 23.9% in secondary diabetes, P < 0.001 in all three cases) than among healthy blood donors (4.7%). Two patients with NIDDM had CD. Of the IDDM group (n = 848), 8 had previously diagnosed CD and 14 more (of whom 7 could be biopsied) were EMA positive. All had villous atrophy. The minimum prevalence of CD (including probable cases) in IDDM was 2.6% (22/848). Patients with previously known CD had more symptoms (P < 0.001), more deficiency states (P < 0.001) and more autoimmune diseases (P < 0.04) than those identified by screening. IDDM patients with a diabetes duration of 31-40 years were characterised by a higher prevalence of CD than patients with a duration of less than 30 years (6.7% vs. 1.7%; P < 0.02).
  
  
  CONCLUSIONS
  Serial analysis of GA and EMA confirmed a high prevalence of CD in adult IDDM (2.6%). False-positive IgA-GA test results are frequent in patients with diabetes, irrespective of type. EMA analysis is the preferable screening tool for CD in diabetes.
authors.affiliation: Department of Medicine, University of Lund, University Hospital, Malmö, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Sjöberg
authors.forename: K F
authors.initials: KF
authors.lastname: Eriksson
authors.forename: A
authors.initials: A
authors.lastname: Bredberg
authors.forename: R
authors.initials: R
authors.lastname: Wassmuth
authors.forename: S
authors.initials: S
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D015995:Prevalence
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D005903:Gliadin