Walsh C H, Cooper B T, Wright A D, Malins J M, Cooke W T
Q J Med. 1978 Jan;47(185):89-100.
Fourteen adults in whom diabetes mellitus and coeliac disease coexist, are described. In no patient was coeliac disease diagnosed (biopsy proven) before the age of 28 years. Diabetes was recognized before coeliac disease in all except one. Diabetic control was very unstable and hypoglycaemia particularly troublesome before treatment with a gluten free diet. Following gluten restriction, insulin requirement increased in six patients, and diabetic control became more stable. Diarrhoea due to coeliac disease in a patient with coexisting diabetes, may be mistakenly diagnosed as 'diabetic diarrhoea'. However, certain clinical and laboratory features should arouse suspicion that the diarrhoea is not of diabetic origin. These included a history of gastrointestinal symptoms preceding the diagnosis of diabetes, the occurrence of repeated hypoglycaemia, absence of neuropathy, anaemia, low serum folate, low serum albumin and a malabsorption pattern on small bowel radiography. A definitive diagnosis of coeliac disease can be made only jejunal biopsy. The opportunity to diagnose coeliac disease in adult diabetics will usually fall to the diabetologist and wider use of jejunal biopsy in diabetics with chronic or recurrent diarrhoea is suggested.
本文描述了14例同时患有糖尿病和乳糜泻的成年人。在28岁之前，所有患者均未被诊断出患有乳糜泻（活检证实）。除1例患者外，所有患者均在乳糜泻之前就已确诊患有糖尿病。在采用无麸质饮食治疗之前，糖尿病的控制非常不稳定，低血糖尤其棘手。限制麸质摄入后，6例患者的胰岛素需求量增加，糖尿病控制变得更加稳定。糖尿病合并乳糜泻患者的腹泻可能会被误诊为“糖尿病性腹泻”。然而，某些临床和实验室特征应引起怀疑，即腹泻并非源于糖尿病。这些特征包括糖尿病诊断之前的胃肠道症状史、反复出现低血糖、无神经病变、贫血、血清叶酸水平低、血清白蛋白水平低以及小肠造影显示吸收不良模式。只有通过空肠活检才能确诊乳糜泻。成年糖尿病患者中诊断乳糜泻的机会通常落在糖尿病专科医生身上，建议对患有慢性或复发性腹泻的糖尿病患者更广泛地使用空肠活检。
