Michael J. Rensch, MD; John A. Merenich, MD; Michael Lieberman, PhD; Brian D. Long, BS, CRC; Dirk R. Davis, MD; Peter R. McNally, DO
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.
Prospective cohort study.
U.S. Army medical center.
47 patients with insulin-dependent diabetes mellitus.
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.
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.
Celiac disease appears to be more common among patients with insulin-dependent diabetes mellitus than in the general U.S. population (P < 0.001). Two of the three patients with coexistent disease in this study had subclinical or latent celiac disease.
Rensch MJ, Merenich JA, Lieberman M, et al. Gluten-Sensitive Enteropathy in Patients with Insulin-Dependent Diabetes Mellitus. Ann Intern Med. 1996;124:564–567. doi: 10.7326/0003-4819-124-6-199603150-00004
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Published: Ann Intern Med. 1996;124(6):564-567.
Cardiology, Celiac Disease and Malabsorption, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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