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% 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 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.