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. Design: Prospective cohort study. Setting: U.S. Army medical center. Patients: 47 patients with insulin-dependent diabetes mellitus. Measurements: 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% Cl, 1.4% to 17.5%) had positive antiendomysial antibody test results and small-bowel biopsy specimens consistent with celiac disease. The 95% Cl 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 anti-body-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 < 0.001). Two of the three patients with coexistent disease in this study had subclinical or latent celiac disease.
It may be advisable to test patients with insulin-dependent diabetes mellitus for celiac disease if the patients have altered bowel habits. Researchers tested 47 patients with insulin-dependent diabetes mellitus for evidence of celiac disease. Three of the 47 patients (6.4%) tested positive for celiac disease with an antibody test as well as with biopsy. Two of these three also had tests to evaluate bone mineral density. Both of these patients had bone mineral densities that were two times lower than normal. Only one of these three patients had diarrhea symptoms characteristic of celiac disease. One of the patients tested for bone mineral density also did not absorb the sugar D-xylose at normal levels. None of the patients had low red blood cell counts.