Disordered eating in girls with Type 1 diabetes: Examining directions for prevention

Abstract

Girls with Type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]) have been identified to be at an increased risk for developing bulimia nervosa (BN) and subthreshold eating disorders. The co-occurrence of these conditions can severely compromise the physical health of these individuals and can even accelerate mortality. The use of a unique and dangerous purging behaviour called insulin manipulation is of particular concern among young women with IDDM because this has been shown to be associated with metabolic dysfunction and devastating complications such as retinopathy. Therefore, development of prevention programs designed to protect girls with IDDM against developing disordered eating is a critical priority. To date, however, no such prevention programs have been evaluated in the literature. Therefore a general overview of research in the areas of IDDM and disordered eating is provided, as well as a review of the design and content of effective eating disorder intervention programs, with suggestions about how such programs should be adapted, in order that they can be used and evaluated with an IDDM population.

Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth—Australia

“…Second, many studies have typically used measures developed and standardized for the general population (Young-Hyman & Davis, 2010), raising questions regarding their suitability and applicability to assess DEB or clinical threshold in individuals with type 1 diabetes. For example, general screening tools may overestimate problematic eating behaviors in people with type 1 diabetes when recommended diabetes management practices (e.g., restricting certain food groups, portion control) are misconstrued as DEB (Hanlan et al, 2013;Markowitz et al, 2010;Powers et al, 2013;Starkey & Wade, 2010;Young-Hyman & Davis, 2010). This may explain inconsistencies in prevalence data with some studies finding no significant differences in DEB or ED between young people with and without type 1 diabetes (Meltzer et al, 2001;Peveler, Fairburn, Boller, & Dunger, 1992;Striegel-Moore, Nicholson, & Tamborlane, 1992) and others finding evidence of an elevated risk (Colton et al, 2004;Jones, Lawson, Daneman, Olmsted, & Rodin, 2000;Neumark-Sztainer et al, 2002;Nielsen, 2002;Young et al, 2013).…”

Primary care of female adolescents with type 1 diabetes mellitus and disordered eating

“…). These behaviours may include fasting, diet pill use, excessive exercising, self‐induced vomiting and misuse of laxatives and diuretics (Starkey & Wade ). Disordered eating behaviours are much more common than full syndrome feeding and eating disorders of anorexia nervosa (starvation), bulimia nervosa (binge‐purge disorder), binge eating disorder and other specified feeding or eating disorders (meeting partial criteria for any of the disorders in the feeding and eating diagnostic class) (Goodwin et al .…”

“…). The behaviour occurs at a higher frequency among older as compared with younger adolescents, possibly due to older adolescents having less adult supervision and the ease, availability and discretion of the weight‐loss behaviour (Starkey & Wade ). Although insulin misuse is the most common method of disordered eating among adolescents with T1DM (Colton et al .…”

“…, Hasken et al . , Starkey & Wade ). On diagnosis and initiation of insulin therapy, glucose levels stabilize.…”

“…, Smith et al . , Starkey & Wade ). Following this strict dietary regimen to manage blood glucose and weight may begin a pattern of obsessive restricting, binge eating and purging behaviours to intensify personal control, particularly if already pre‐occupied with food, weight and body size and shape (Maharaj et al .…”