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Celiac disease was featured prominently, for the first time to my
knowledge, at the annual meeting of the American Diabetes Association in
Boston (June 21-24).

Dr. Marian Rewers, Univ. of Colorado, organized a 2 hour session
incompletely titled "Celiac Disease: A Model for IDDM Etiology". It was
attended by 160-240 and followed by a long list of questions and comments
from the floor. Dr. Rewers directs the DAISY project that's looking for
environmental influences in the development of both Type I diabetes (IDDM)
and celiac disease.

In his introduction, Dr. Rewers made it clear that the unspoken purpose of
the session was to alert diabetic professionals that celiac disease often
presents in unusual ways and that its incidence among Type 1s is enhanced.
Supporting this, Dr. Maki from Finland reported that only 23% of some 3000
celiacs diagnosed by biopsy had classical (meaning gastrointestinal?)
symptoms. 36% came from minor symptoms and 13% by chance. Meanwhile, Dr.
Rewers in a previously unannounced talk gave an antibody incidence rate of
4 or 5% among Type Is, presumably from Colorado --I don't  have a
reference for that yet. The other speaker was Fraser Scott, Ph.D. from
Toronto who focused on the etiology (development) of diabetes. Dr. Maki
had covered that for celiac, as well. Both parallels and differences.

Dr. Rewers also presented a paper about the incidence of CD among
relatives of Type I's -- 2.7% versus a risk of 8.7% in that same sample,
about the same % as among relatives of celiacs. Antibody diagnosed but all
biopsies to date were positive.

All positive relatives carried the HLA-DR3 allele or the HLA-DQB1*302
allele. Dr. Rewers tells me the dominant DR3 among  CD diabetes patients
is well known  as an allele characterized by "slowly progressive
(diabetic) complications". So some consolation for those doubly diagnosed
with Type I and celiac disease.

Most revealing question from the floor: (to Dr. Maki) "do you mean you
treat the asymptomatic patient with flat villi in Finland?"

Best comment from the floor from a member of this list, Katherine
Marschilok, MSN, RN, CDE "You routinely screen your Type I patients for
thyroid disease. Celiac disease is just as common among them. Shoudn't you
also be testing for that?" Warm applause and a comment from the chair, Dr.
Ake LernMark, that he was just about to close with that remark.

Note that Dr. Rewers figure of 4-5% celiac EMAs among Type Is implies that
the true incidence of celiac disease in the US is equal to that of Type
Is:  the incidence of Type I's among biopsied celiacs is about 5 % also.
Hence the 1 in 200 iceberg.

                              Kemp Randolph
                              Long Island
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Kemp Randolph <[log in to unmask]>
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