Psychosocial care in diabetes
Eating disorders in girls and women with type 1 diabetes: A longitudinal study of prevalence, onset, remission, and recurrence
This study describes the longitudinal course of disturbed eating behavior and eating disorders in a cohort of females with type 1 diabetes over 14 years.
Summary points
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- Teenage girls and women with type 1 diabetes are at significantly increased risk of disturbed eating behaviors, such as dieting, fasting, binge-eating and a range of other compensatory and purging behaviors, compared with their non-diabetic peers; disturbed eating behaviors can interfere with diabetes management.
- Deliberately under-dosing or omitting insulin to induce hyperglycemia and loss of glucose in the urine to control weight is a purging behavior unique to individuals with type 1 diabetes; it is one of the mechanisms underlying the association between disturbed eating behavior and eating disorders and poor metabolic control.
- A total of 126 girls with type 1 diabetes (disease duration of >6 months) aged 9 to 13 years (mean age: 11.8±1.5 years) were recruited at the Diabetes Clinic at The Hospital for Sick Children in Toronto between 1998 and 2001 and followed for 14 years.
- Assessments were performed at baseline (time 1) and 1 (time 2), 2 (time 3), 3 (time 4), 5 (time 5), 8–10 (time 6) and 10–14 (time 7) years after time 1; at times 1–4, the children’s eating disorder examination (cEDE) was used, and at times 5–7, the eating disorder examination (EDE) was used.
- At time 6 (age range: 17.3–23.2 years), 19.8% (16/81) suffered from a full-syndrome or sub-threshold eating disorder.
- At time 7 (age range: 19.2–27.8 years), disturbed eating behavior was reported by 59.2% (42/71) of participants.
- At time 6, HbA1c was significantly higher among women with a current eating disorder than in those without (10.06±1.5% [86±14 mmol/mol] vs 8.7±1.6% [72 ± 15 mmol/mol]; t=2.2, df=52, P=0.04, d=0.83).
- At time 7, a trend towards higher HbA1c among those with an eating disorder compared with those without (9.0 ± 1.8% [75±17 mmol/mol] vs 8.2±1.3% [66±12 mmol/mol]; t=1.9, df=51, P=0.07, d=0.51).
- Estimates of the cumulative probability of disturbed eating behavior onset remained reliable up to age 23 years; 79% experienced onset of disturbed eating behavior by this point.
- Estimates of the cumulative probability of eating disorder onset remained reliable up to age 25 years; 60% experienced onset of an eating disorder by this point.
- Both disturbed eating behavior and eating disorders tended to be persistent, with a mean time from observed onset to detected remission of 6.0 and 4.3 years, respectively, and significant estimated risk of recurrence.
- Disordered eating is a common and serious concern among girls and young women with type 1 diabetes.
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Colton PA et al. Diabetes Care 2015; 38: 1212. doi: 10.2337/dc14-2646
Treatment outcome of patients with comorbid type 1 diabetes and eating disorders
This study compared treatment outcomes, dropouts, eating disorder psychopathology and personality characteristics in individuals with eating disorders with comorbid type 1 diabetes and those without.
Summary points |
- Overall, 40 adult female patients diagnosed with eating disorders according to the DSM-IV were recruited at the Eating Disorder Unit of the Bellvitge Hospital (Barcelona, Spain) between April 1999 and June 2012, 20 with comorbid type 1 diabetes (disease duration >6 months; mean age: 25.3 years) and 20 controls (mean age: 28.0 years) matched for socio-demographic variables.
- Patients received the following treatments:
- 16 sessions of cognitive-behavioral therapy for those with bulimia nervosa, binge eating disorder and eating disorder not otherwise specified;
- 3 months daytime hospitalization for anorexia nervosa patients.
- Assessments included semi-structured interviews conducted by experienced psychologists and psychiatrists, a battery of psychological questionnaires, including the Temperament and Character Inventory–revised (TCI-R) and the Eating Disorders Inventory-2 (EDI-2) and a visual analogue scale to assess the motivational stage of change.
- In patients with type 1 diabetes, HbA1c measured nearest to the interview was used as an indicator of glycemic control.
- Age of onset of eating disorder was 19.5 years (SD=7.4) for patients with type 1 diabetes and 19.4 (SD=7.5) for controls.
- The majority (90%, n=18) of patients with type 1 diabetes acknowledged skipping or reducing insulin doses to control weight.
- Patients with type 1 diabetes were significantly less likely than controls to self-harm (p<0.012; d:1.03), have suicidal ideation (p<0.030; d:0.80) and suicidal behavior (p <0.039; d:0.79).
- Patients with type 1 diabetes scored significantly lower on motivation to change and level of consciousness about their eating disorder, and had significantly lower persistence compared with controls.
- Three quarters of patients in the control group (n=15) showed partial or full remission compared with 50% (n=10) of those with type 1 diabetes.
- The number of dropouts was higher among patients with type 1 diabetes compared with controls and they stopped treatment significantly earlier (χ2=4.50, df=1, p=0.034).
- Low levels of motivation to change and insulin abuse in patients with type 1 diabetes and eating disorders may suggest that in devising a treatment strategy aimed at this population, clinicians should consider the individual’s personality and role of insulin abuse in determining the appropriate intervention.
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Custal N et al. BMC Psychiatry 2014; 14: 140. doi: 10.1186/1471-244X-14-140