Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

Abstract

OBJECTIVETo compare clinical characteristics and outcome of type 1 diabetes mellitus (T1DM) between patients with and without a clinically recognized eating disorder (ED). RESEARCH DESIGN AND METHODSA total of 52,215 T1DM patients aged 8 to <30 years from the prospective diabetes data acquisition system DPV were analyzed. A total of 467 patients had an additional diagnosis of ED according to DSM-IV criteria (anorexia nervosa [AN], n = 141 [female: 94.3%]; bulimia nervosa [BN], n = 62 [90.3%]; and EDs not otherwise specified, including binge-eating disorder [EDNOS], n = 264 [74.2%]). Groups were compared using multivariable regression. Cox proportional hazard ratios were calculated for the association between ED and retinopathy. RESULTSAfter adjustment for age, sex, and duration of diabetes, patients with ED revealed higher HbA 1c (no ED vs. AN, BN, or EDNOS, respectively: 8.29 6 0.01% [67.1 6 0.1 mmol/mol] vs. 8.61 6 0.15% [70.6 6 1.6 mmol/mol], 9.11 6 0.23% [76.1 6 2.5 mmol/mol], or 9.00 6 0.11% [74.9 6 1.2 mmol/mol]) and a higher rate of pathological insulin injection sites (48.4 vs. 64.3, 64.1, or 62.1%). Furthermore, ketoacidosis (5.7 6 0.1 vs. 12.1 6 2.1, 18.0 6 4.1, or 12.9 6 1.6 events per 100 person-years) and hospitalization (54.9 6 0.3 vs. 89.3 6 6.0, 132.0 6 12.7, or 91.0 6 4.4 per 100 person-years) were more common, and duration of hospital stay was longer (4.81 6 0.01 vs. 11.31 6 0.21, 18.05 6 0.48, or 8.44 6 0.13 days per year). All P values were <0.05. Patients with BN and EDNOS had a 2.5-fold (95% CI 1.3-4.8) and a 1.4-fold (0.8-2.3) higher risk for retinopathy, whereas AN patients had no increased risk (0.9 [95% CI 0.4-2.3]). CONCLUSIONSDiabetes health care professionals should be aware of comorbid EDs in pediatric/ young-adult T1DM patients. An ED diagnosis is associated with worse metabolic control and higher rates of diabetes complications.

Factors associated with disordered eating behaviours in adolescents with Type 1 diabetes

“…Our findings confirm recent studies that have reported associations between more disordered eating behaviours and female sex , higher BMI and poorer glycaemic control in people with Type 1 diabetes. In a recent large epidemiological study of 52 215 children and young adults with Type 1 diabetes, 467 individuals had an eating disorder according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders criteria . Those with eating disorders had higher HbA 1c levels as well as higher rates of diabetic ketoacidosis and risk factors for future complications compared with those without eating disorders.…”

Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria

“…Recent observational studies based on the “German‐Diabetes‐Database (Diabetes‐Patienten‐Verlaufsdokumentation—DPV)” derived psychiatric diagnoses from patients' medical records and not from diagnostic interviews. They showed rates of depression and eating disorders far below the general prevalence rates, confirming this problem of underdiagnosing . Diagnostic interviews are regarded to be the most accurate way to diagnose internalizing disorders .…”

‘Diabulima’ through the lens of social media: a qualitative review and analysis of online blogs by people with Type 1 diabetes mellitus and eating disorders

“…It is not surprising that the blogs discussed hospitalization after DKA, as insulin omission attributable to diabulimia increases DKA risk significantly . Although DKA and severe hypoglycaemia are acute diabetes complications, we observed that bloggers with diabulimia experienced repeated and cyclical patterns of these complications.…”