Detailed tests found that 4.6 percent of 218 young patients with diabetes had celiac disease, says a report in the latest issue of the Journal of Pediatric Gastroenterology.
"Based on our work here, every one of our diabetic patients now gets screened for celiac disease," says study leader Dr. Steven Werlin, professor of pediatric gastroenterology at the Medical College of Wisconsin.Gluten is a protein in wheat, rye and barley. In celiac disease, the body's immune system mistakenly identifies and attacks gluten in the intestines. Damage to the intestinal lining leads to reduced absorption of important nutrients, which can cause anemia, failure to grow properly and other problems.
Many patients in the Wisconsin study did not have obvious symptoms, Werlin says. Their celiac disease was diagnosed by taking samples of tissue from the lining of the intestines and looking for inflammation and cell damage.
It's important to detect even mild, symptomless cases of celiac disease in diabetics, Werlin says. "For one thing, diabetes with untreated celiac disease is harder to manage, and among other complications, there is an increased risk of lymphoma (malignant tumors) of the small bowel."
Until recently, doctors believed only about 1 percent of people with diabetes in the United States had celiac disease, Werlin says. European studies have found a much higher incidence there. "Our findings are compatible with the European studies," he says.
Newer studies have raised the estimate of the incidence in the United States, says Dr. Stefano Guandalini, professor of pediatrics at the University of Chicago and a member of the medical board of the Celiac-Sprue Association/United States of America.
"The estimates have been fluctuating between 2 and 6 percent," he says. "We have done similar studies and found similar prevalence."
Celiac disease is more likely to go undetected in the United States than in Europe, partly because the American diet is richer, making the symptoms more difficult to detect, says Mary Schluckebeier, president of the Celiac-Sprue Association. "In Europe, celiac disease is considered the most frequent genetic disease. Physicians are less likely to look for it in the United States, where it is considered to be a rare disease," she says.
The incidence of celiac disease among the general American population is unknown, with estimates ranging from one in 3,000 to as high as one in 250. She says the incidence clearly is higher among persons with insulin-dependent (Type I) diabetes and among patients with other genetic diseases.
"It appears that if you look at the genetic marker for celiac disease, it is a close neighbor of the marker for Type I diabetes," she says. "Both are autoimmune diseases. There is a greater possibility if you have one autoimmune disease, you will have another."
The treatment for celiac disease is a gluten-free diet. Specially manufactured substitute foods, including gluten-free bread, pasta and flour, are available. Other foods, including rice, corn, meat, fish, eggs, dairy products, fruits and vegetables can be eaten without worry because they do not contain gluten.
What To Do
Parents of children with Type I diabetes should be alert for the symptoms of celiac disease, which include bulky, unusually smelly feces, failure to gain weight properly, excess intestinal gas and sometimes acute diarrhea. Undetected celiac disease in adults can cause fatigue, breathlessness, swelling of the legs and abdominal pain.
Detailed information about celiac disease is available from the Celiac-Sprue Association/United States of America and the National Institute of Diabetes and Digestive and Kidney Diseases.
And the American Diabetes Association explains Type I diabetes.