Screening for coeliac disease in adult insulin‐dependent diabetes mellitus

• Published in: Journal of internal medicine 1998-02, Vol.243 (2), p.133-140
• Main Authors: SJÖBERG, K, ERIKSSON, K. F, BREDBERG, A, WASSMUTH, R, ERIKSSON, S
• Format: Article
• Language: English
• Subjects: @.06. coeliac disease; Adult; Associated diseases and complications; Autoantibodies - blood; Biological and medical sciences; Celiac Disease - complications; Celiac Disease - diagnosis; Celiac Disease - immunology; Celiac Disease - prevention & control; diabetes mellitus; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diagnosis, Differential; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; endomysial antibodies; Enzyme-Linked Immunosorbent Assay; Female; Gliadin - immunology; gliadin antibodies; Humans; IDDM; Immunoglobulin A - blood; Male; Mass Screening - methods; Medical sciences; Middle Aged; Muscle Fibers, Skeletal - immunology; Prevalence
• ISSN: 0954-6820; 1365-2796
• DOI: 10.1046/j.1365-2796.1998.00256.x

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.