Celiac disease in type 1 diabetes mellitus in a North American community: Prevalence, serologic screening, and clinical features

OBJECTIVES: To estimate the prevalence of celiac disease (CD) In pediatric and adult type I diabetes mellitus in a defined population and to describe clinical features and HLA class 11 genotypes predictive of CID In screened patients with type I diabetes. PATIENTS AND METHODS: All residents of Olmsted County, Minnesota, with type I diabetes mellitus on the prevalence date January 1, 2001, were Identified with the use of an established medical records linkage system (Rochester Epidemiology Project) and defined clinical criteria. Consenting patients underwent serologic screening with endomysial antibody and tissue transglutaminase antibody testing and Intestinal biopsies to confirm the diagnosis of CO. A subset of screened patients also underwent HLA class 11 genotyping. Quality-of-life screening (Medical Outcomes Study 36-Item Short-Form Health Survey) was completed in a subset of patients at the time of serologic screening. RESULTS: Overall, 392 Olmsted County residents with type I diabetes on January 1, 2001, were Identified. A total of 158 patients with type I diabetes were tested, representing 400% (158/392) of the enumerated diabetic population, and 11 had biopsy-proven CD for an estimated point prevalence of 7.0% (95% confidence Interval, 3.5%-12.1%). Most CD-positive diabetic patients were asymptomatic and expressed an at-risk CD haplotype with at least one of but not bath HLA DQ2 or DQ8. CONCLUSIONS: Celiac disease Is not rare In North American patients with type 1 diabetes, and most CD-positive diabetic patients are asymptomatic Irrespective of age at screening.