The incidence of IDDM in the age group over 30 years was estimated in a historical prospective study, using clinical and biochemical measurements at onset as criteria for classification. The study population, nearly one million, represents 20% of the Danish population. The degree of ascertainment was > 99%. One thousand two hundred and forty patients were treated with insulin during the study period (1973-77). Based on the clinical and biochemical variables, the patients were classified into three groups: insulin-dependent diabetes mellitus (IDDM) accounted for 16.2%, insulin-treated diabetes mellitus for 54.1% and short-term treated diabetes mellitus for 29.6% of the total insulin-treated group. The incidence of IDDM in the age group over 30 years at onset was 8.2 100,000(-1) year-1. The cumulative incidence rate (0-90 years) was 1.5-1.6 per cent. The present study indicates that IDDM may develop at any age. Thus the life-time risk of developing IDDM is higher than hitherto expected.

The subject of concurrent eating disorder (ED) and insulin-dependent diabetes mellitus (IDDM) has attracted considerable attention for more than a decade. This paper is the ®rst attempt at a quantitative summary of this ®eld. Uncontrolled studies and anecdotal reports suggest an increase of ED in IDDM patients, and also an increase of IDDM in ED patients. Reviews and case reports underscore the dif®culty of treating patients with both disorders, the early occurrence of neurovascular complications in these patients and the need for controlled studies. Meta-analysis of ®ve controlled studies do not support an hypothesis of increased risk of ED in female IDDM patients for any type of ED: (anorexia nervosa, AN; bulimia nervosa, BN; unspeci®ed or subclinical ED, ED-NOS). Findings from register studies do not support an hypothesis of increased occurrence of IDDM in female AN-patients. An hypothesis of increased risk of retinopathy is supported by two controlled studies. The interest in concurrent ED and IDDM is thus not justi®ed by any increase in concurrence, but in the early occurrence of clinically signi®cant retinopathy (OR 8.04; 95 per cent CI 4.0±16.1), and other diabetic complications. The existing studies do not seem to have taken full advantage of existing diabetes-speci®c knowledge, whereas knowledge related to the eating disorders are fully incorporated. Future epidemiological studies should be cause-seeking rather than merely descriptive. These studies should try to relate risk factors, protective factors and speci®c risk behaviours with health outcome i.e. complications and mortality. *

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