Issue 138 Item 13 The Association Between Celiac Disease And Diabetes

When celiac disease is diagnosed before diabetes mellitus, clinical presentation of the diabetes is severe, say researchers. Researchers from the Universities of Parthenope and Federico II, Naples, Italy, enrolled 383 type I diabetics. Thirty-two of these patients also were diagnosed with celiac disease (8.3% of the total). Celiac disease was diagnosed before the diabetes in eight patients while the remainder were diagnosed with celiac disease after the onset of diabetes. Furthermore, 18.7% of celiac disease patients had a third autoimmune disorder.

Ketoacidosis and other autoimmune diseases were more common in patients diagnosed as having celiac disease after the onset of diabetes compared with diabetes alone. This difference did not emerge in those that developed celiac disease after the onset of diabetes.

Patients diagnosed with celiac disease after the onset of diabetes and who had not developed symptoms were less likely to be female, were older at the onset of diabetes and were less likely to develop ketoacidosis or express another associated autoimmune disease than symptomatic patients.

The authors concluded that celiac disease and diabetes mellitus could manifest as "a wide clinical spectrum". They speculated that the distinct phenotypes might arise from different genotypes. Diabetologia 2002;45:1719-1722