Gluten-Sensitive Enteropathy in Patients with Insulin-Dependent Diabetes Mellitus

15 March 1996 | Volume 124 Issue 6 | Pages 564-567

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% 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 < 0.001). Two of the three patients with coexistent disease in this study had subclinical or latent celiac disease.

Author and Article Information

From Fitzsimons Army Medical Center, Aurora, Colorado, and the University of Colorado Health Sciences Center, Denver, Colorado.
Disclaimer: The opinions and assertions contained herein are those of the authors and are not to be construed as official policy or as the views of the Department of Defense.
Requests for Reprints: Peter R. McNally, DO, Gastroenterology Service, Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045-5000.
Current Author Addresses: Dr. Rensch: 20 Alondra Court, Colorado Springs, CO 80919.