The prevalence of coeliac disease in adult diabetes mellitus

Coeliac disease occurs more commonly in children with insulin-dependentdiabetes mellitus (IDDM) than in the general population, butthe prevalence of coeliac disease in adults with diabetes isunknown. We therefore screened an adult hospital-based diabeticpopulation using IgA antigliadin antibody (IgA-AGA) to identifythose patients requiring intestinal biopsy. In 1 year, 1789patients (43% IDDM, 57% NIDDM) were screened, and 73 had raisedIgA-AGA. Of these patients, 49 agreed to duodenal biopsy and13 (10 IDDM) had coeliac disease. Selective IgA deficiency wasfound in eight patients, one of whom had coeliac disease. Ofthese 14 patients with newly diagnosed coeliac disease, fourhad microcytic anaemia, nine a low serum ferritin, and foura low albumin-corrected calcium. Eight patients had symptomswhich improved on gluten withdrawal. Dietary compliance wasmaintained in 6/8 symptomatic patients, but only in 1/6 withoutsymptoms. Included in the 1789 patients were four (all IDDM)with known coeliac disease. The overall prevalence of coeliacdisease in adult patients with IDDM was 1:50 compared with 1:340in NIDDM. Coeliac disease is common in adults with IDDM andmay cause malabsorption and ill health. It should be suspectedin any IDDM patient with gastrointestinal symptoms or unexplainedanaemia.