Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus

Abstract

Introduction: Prevalence of coeliac disease (CD) in patients with diabetes mellitus type 1 (DM) has been estimated from 1.7 to 16.4% in different populations. Aim of study: The aim of the study was to evaluate the frequency of CD in patients with DM and to assess whether the coexistence of CD has an influence on physical development of the patient and clinical course of DM. Material and methods: 459 patients with DM (214 girls, 245 boys, mean age 13.7 years). All patients, except 4 in whom CD had been diagnosed before development of DM, were screened for endomysial antibodies (EMA). EMA were detected by immunofluorescence. The following parameters were evaluated: height and body mass index (BMI) expressed as standard deviation (SD) score, hemoglobin concentration (Hb) and clinical course of diabetes. Results: EMA were positive in 38 patient. In 26 patients villous atrophy was found confirming the diagnosis of CD, in 4 small bowel mucosa was normal. Out of the 8 patients initially positive, the EMA of 7 later became negative. The prevalence of CD in DM was estimated for 6.5%. Diabetics with CD had an earlier onset of diabetes (6.45 years vs 8.6 years) and their Hb was lower (12.9 g/dl vs 13.8 g/dl). No differences in height-SD, BMI-SD, HbA1c, insulin requirement and frequency of severe hypoglycaemia were found. In patients with CD and DM after at least 6 months of gluten free diet, height-SD and BMI-SD increased. Hb, HbA1c, insulin requirement did not change. Conclusions: Routine serological screening for CD should be performed in patients with DM because of high prevalence and the oligosymptomatic course of CD. The test should be repeated because of the possibility of seroconversion. Copyright © 2007 Cornetis.