Review
Eating disoders in type 2 diabetic people: Brief review

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Abstract

Background

Relationship between type 1 diabetes and Eating disorders is well-known, less information exists on the relationship between type 2 diabetes (T2DM) people and eating disorders.

Aim

Review information on the prevalence and impact of type 2 diabetes and eating disorders comorbidity.

Methods

Search in Medline and PubMed relevant articles on the aforementioned co-morbidity. Review includes articles on epidemiological, clinical and therapeutics aspects.

Conclusions

Disordered eating behaviours may affect around 40% of T2DM people, being the predominant clinical forms: Eating Disorders Non otherwise specified (EDNOS), Night Eating Syndrome (NES) and Binge Eating Disorder (BED), however, population-based estimates of T2DM and ED comorbidity are mandatory to determine the prevalence of ED in T2DM people. The association between both entities has a consequence which is an impairment of metabolic control, associated to increase risk of vascular complications and difficult body weight loss, basis of T2DM treatment.

Introduction

People suffering from any type of chronic disease, need to make minor or major lifestyle adjustments. These adjustments can lead to either successful adherence to medical regimens and control of the disease, or among other things, ineffective or maladaptive coping [1].

Type 2 diabetic people (T2DM) have to adhere to some responsibilities such as: modification of lifestyle (diet, exercise, and weight control), self-monitoring of blood glucose concentrations, foot care, and administration of medications. Difficulties in adhering these tasks can be associated with suboptimum glycaemic control [2]. Psychological problems such as depression, anxiety [3], [4] and eating disorders (ED) [5] are common in diabetic people, and are associated with bad metabolic control and diabetes complications.

The association of type 1 diabetes mellitus and Eating disorders are well known [6], [7], while information on the association between type 2 diabetes mellitus with abnormal eating attitudes is scarce. The present manuscript focuses on the association of T2DM and ED and its consequences.

Section snippets

Definition and types of eating disorders

Eating disorders are psychiatric diseases characterized for eating behaviours that negatively affect the health and can dominate the patient́s life. Such behaviours interfere with the ability to obtain an adequate nutrition. ED typically affect teen and young adults, although can affect other ages [8].

In the present review we have not considered the classification of ED including in the recent published DSM 5 [9], since all articles we have revised using DSM 4 or DSM 4TR to classify their

Diagnosis of ED

Diagnosis of well-defined psychiatric diseases requires the use of specific psychological tests for each clinical entity, used mainly as screen method, and a structured or semi-structured interview based on the DSM criteria.

Assessment ED in T2DM patients should include questions about body image and shape, binge eating and purging behaviours. Clinicians should pay particular attention to possible diabetes medication manipulation in patients with T2DM, as well as the reasons for motivation

Epidemiology of disordered eating behaviours in type 2 diabetes people

Remarkably, population-based estimates of the co-prevalence of T2DM and ED from large nationally-representative samples remain to be documented. The co-occurrence of both medical entities was shown to be widely variable from data derived mainly from clinic-based samples. A review of these studies, all of them obviously, basis on diagnosis criteria from DSM IV or previous DSM versions, showed the following results:

Herpertz et al. [12], focuses on the subsample of 321 T2DM patients, 154 males and

Inter-relationship between ED with type 2 diabetes

The relationship between both ED and type 2 diabetes mellitus are double, first, type 2 diabetic patients under dietary regimens and those with overweight or obesity have an increase risk to development ED [11], [13], [14], [22], [23]. Second, ED in T2DM patients induces gain in body weight that increases the risk to develop type 2 diabetes mellitus [24].

Consequences of disordered eating behaviours in T2DM patients

Since one of the main characteristics of ED is an obsessive behaviour that can control the patients’ life, it is expected that the association of T2DM with any ED impair the metabolic control of these patients.

The few studies published on this topic suggest that ED is only moderately or not associated with the metabolic control of patients with T2DM (12, 23 and 24). However, other studies demonstrated worse outcomes in patients with comorbid ED and T2DM, showing impaired metabolic control [14],

Management of patients with type 2 diabetes and ED

ED must be routinely assessed in patients with type 2 diabetes in order to early diagnosis of these conditions.

As occur with patient with type 1 diabetes and ED, the management of T2DM with ED should be treated by a team composed of at least a psychologist, diabetologist/endocrinologist, Educator/Nutritionist and frequently psychiatrist [6].

The treatment of patients with T2DM and ED has at least the following components: psychotherapy, glycaemic control, Nutritional counselling and Diabetes

Conclusions

Disordered eating behaviours may affect up to 40% of patients with type 2 diabetes mellitus, being the predominant clinical forms: EDNOS, NES and BED, however, this information has been obtained in clinical series; thus population-based studies are needed to determine the prevalence of ED in T2DM people. Different types of ED have in common an obsessive component that dominate the daily life, being the main consequence a poor metabolic control associated with increased risk to development of

Acknowledgement

The present investigation was support by a Grant from Sociedad Española de Diabetes.

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