Frequency of coeliac disease in Hungarian children with type 1 diabetes mellitus.
Coeliac disease and type 1 diabetes mellitus can frequently coexist, presumably due to a common genetic predisposition. The present study was designed to evaluate the frequency of coeliac disease among Hungarian diabetic children and to study the effect of gluten-free diet on glycaemic control. A total of 205 diabetic children (age range 2.0-17.0 years, median 11.6 years) were screened for coeliac disease by determination of IgA-endomysium (EMA) antibodies. In the positive cases, a jejunal biopsy was performed and, in addition to routine histology, the number of intraepithelial gamma/delta T-cells was also determined. Insulin requirement, glycosylated haemoglobin level and body mass index of diabetic children with coeliac disease were determined before and 3 months after the introduction of gluten-free diet. IgA-EMA was positive in 24 cases, 17 of them (8.3% of all diabetic children) had a subtotal villous atrophy and thus coeliac disease was diagnosed. In all but two of these children, the mean number of gamma/delta T-cells was elevated (above 7 cells/mm). Of the remaining seven patients with positive EMA but normal villous structure, five (2.4%) had elevated number of epithelial gamma/delta T-cells, indicating probable latent coeliac disease. The insulin requirement of the children had significantly increased 3 months after the introduction of gluten-free diet (median values 0.64 versus 0.48 U/kg per day, P<0.05). Median body mass indices also showed significant elevation after this period (16.8 versus 14.2 kg/m(2), P<0.05) CONCLUSION: the frequency of coeliac disease was high in the studied group. Introduction of a gluten-free diet improved the somatic development of these children. A latent form of coeliac disease is also frequent in children with type 1 diabetes mellitus.
Arató
András
A
1st Department of Paediatrics, Semmelweis University, Bókay János u. 53, 1083 Budapest, Hungary. arato@gyer1.sote.hu
Körner
Anna
A
Veres
Gábor
G
Dezsöfi
Antal
A
Ujpál
Ildikó
I
Madácsy
László
L
D000293:Adolescent; D001323:Autoantibodies / Q000032:analysis; D015992:Body Mass Index; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D005260:Female; D005983:Glutens; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007070:Immunoglobulin A / Q000276:immunology; D007328:Insulin / Q000097:blood; D007413:Intestinal Mucosa / Q000473:pathology; D007958:Leukocyte Count; D008297:Male; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D013601:T-Lymphocytes / Q000378:metabolism
D001323:Autoantibodies; D005983:Glutens; D006442:Glycated Hemoglobin; D007070:Immunoglobulin A; D007328:Insulin