ASSOCIATION OF INSULIN-DEPENDENT DIABETES-MELLITUS AND CELIAC-DISEASE- A STUDY BASED ON SEROLOGIC MARKERS

Background: The association of celiac disease and insulin-dependent di abetes mellitus has been known for some time. In an attempt to clarify this association, the prevalence of celiac disease among diabetic chi ldren was determined, and the risk of insulin-dependent diabetes melli tus was defined in pediatric patients with celiac disease. Methods: Ni nety-three children with diabetes were analyzed for the presence of ce liac disease-related markers (antigliadin and antiendomysial antibodie s) and characteristic alterations in the intestinal mucosa. In another group, 93 children with celiac disease were screened for pancreatic a utoantibodies and pancreatic beta-cell function. Results: Among childr en with insulin-dependent diabetes mellitus, a 6.45% prevalence of cel iac disease was observed, a value significantly higher than that found among healthy controls. In contrast, only three celiac disease patien ts showed potential autoimmunity toward the pancreatic beta cell, a pr oportion not significantly different from that in the general populati on. Additionally, no alteration of glucose metabolism was observed in the antibody-positive patients. Conclusion: The increased risk of celi ac disease among patients with diabetes requires a long follow-up to d etermine the presence of celiac disease markers among patients with di abetes, to avoid potential malignant disease derived from untreated ce liac disease. In contrast, there is no evidence to support an increase d risk of insulin-dependent diabetes mellitus among children with celi ac disease. In accordance with the accepted influence of diet in the d evelopment of autoimmune diabetes, a hypothetical mechanism of protect ion against insulin-dependent diabetes mellitus that is mediated by en vironmental factors related to restricted diet is suggested in this po pulation. (C) 1998 Lippincott-Raven Publishers.