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Screening for coeliac disease in adult insulin‐dependent diabetes mellitus
Author(s) -
Klas Sjöberg,
Eriksson Kf,
Anders Bredberg,
Ralf Waßmuth,
Sten Eriksson
Publication year - 1998
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.1998.00256.x
Subject(s) - medicine , coeliac disease , diabetes mellitus , gastroenterology , immunopathology , antibody , gliadin , disease , endocrinology , immunology , pathology , gluten
Sjöberg K, Eriksson KF, Bredberg A, Wassmuth R, Eriksson S (University of Lund, University Hospital, Malmö, Sweden; and University of Erlangen‐Nürnberg, Erlangen, Germany). Screening for coeliac disease in adult insulin‐dependent diabetes mellitus. J Intern Med 1998; 243 : 133–40. Objectives To study, by sequential screening for gliadin antibodies (GA) and endomysial antibodies (EMA), the prevalence and clinical characteristics of coeliac disease (CD) in adult IDDM patients. Subjects and measurements A series comprising 1664 diabetes patients [848 with IDDM, 745 with non‐insulin‐dependent diabetes (NIDDM) and 71 with secondary diabetes] were screened for GA. IgA‐ or IgG‐GA positive sera were analysed for EMA. Results IgA‐GA were more frequent in all the diabetes subgroups (13.7% in IDDM,12.3% in NIDDM and 23.9% in secondary diabetes, P < 0.001 in all three cases) than among healthy blood donors (4.7%). Two patients with NIDDM had CD. Of the IDDM group ( n = 848), 8 had previously diagnosed CD and 14 more (of whom 7 could be biopsied) were EMA positive. All had villous atrophy. The minimum prevalence of CD (including probable cases) in IDDM was 2.6% (22/848). Patients with previously known CD had more symptoms ( P < 0.001), more deficiency states ( P < 0.001) and more autoimmune diseases ( P < 0.04) than those identified by screening. IDDM patients with a diabetes duration of 31‐40 years were characterised by a higher prevalence of CD than patients with a duration of less than 30 years (6.7% vs. 1.7%; P < 0.02). Conclusions Serial analysis of GA and EMA confirmed a high prevalence of CD in adult IDDM (2.6%). False‐positive IgA‐GA test results are frequent in patients with diabetes, irrespective of type. EMA analysis is the preferable screening tool for CD in diabetes.