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Gluten-Sensitive Enteropathy in Patients with Insulin-Dependent Diabetes Mellitus

Author: Rensch MJ; Merenich JA; Lieberman M; Long BD; Davis DR; McNally PR.
Address: Fitzsimons Army Medical Center, Aurora, Colorado, USA.
Source: Ann Intern Med, 124: 6, 1996 Mar 15, 564-7

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

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glands of the intestinal mucous membrane, also known as the crypts of Lieberkühn, attached to the villi of the intestines.'); return false">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% CI, 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 antibody-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 less than 0.001). Two of the three patients with coexistent disease in this study had sub-clinical or latent celiac disease.

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1 Response:

 
Scott
( Author)
said this on
30 Nov 2012 2:10:43 PM PDT
Test Celiac is a very lonely, isolating disease. You turn down food at social gatherings, because when in doubt go without, and you suddenly become the obsessive freak about her food. It's up for the judges to prove plagiarism




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As mentioned before you said she had rashes, have they checked if that is DH? That is a positive sign of celiac and those with the DH manifestation can have problems getting a postive with the gut biopsy. Here are some links. https://celiac.org/celiac-disease/understanding-celiac-disease-2/dermatitis-herpetiformis/ https://www.gluten.org/resources/getting-started/dermatitus-herpetiformis/ Please read up on this. She can get the rash tested for the disease if it is DH.

Thanks for your reply. I will get her retested. She hasn't had any gluten for a year and is very good at not eating it, but had some cake that night. It's so hard because the Dr who did the biopsy said there wasn't any damage so she can't be classed as Coeliacs. She had ten samples taken, but yes, like you say the intestines are huge.

Thank you for your informative reply. Yes I think you are right in that she is still getting dome cross contamination exposure through chopping boards, condiments etc. I will get her bloods redone to see if her levels have dropped and do a gluten challenge again. We all are on a whole foods diet, buy not all Gluten-Free. I find extended family difficult as because she had a negative biopsy they don't believe she could still possibly have it and aren't so careful with her. Thank you for the links, all very helpful.

Why do you make it so freaking hard to sign up? It's easier to find a replacement for rye bread!

I don't know if there is a simple answer to your question but I try to use "choose my plate" as a guide for my meals. https://www.choosemyplate.gov/MyPlate It basically suggests that when you sit down to a meal - 1/2 of your plate is fruits and veggies and the other 1/2 is dairy, carbs and protein. It's a really simple way to look at my meals and see if they are balanced enough. It also suggests getting very few calories in liquid form and avoiding snacking..... Good luck!