Eating disorder and type 1 diabetes: overview and summing‐up

Abstract

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. *

Mortality in Concurrent Type 1 Diabetes and Anorexia Nervosa

“…Other relevant eating disorders, i.e., bulimia nervosa, eating disorder not otherwise specified (ED-NOS), and "subclinical" or "subthreshold" eating disorders, cannot be studied. Third, the sample size of concurrent cases is small, a not altogether unexpected finding because existing evidence does not indicate an increased occurrence of AN in type 1 diabetic subjects (2).…”

“…A common pathway to early occurrence of diabetes complications and premature death is the widespread use of an osmotic purge of calories via a reduction in insulin (2,23). Because clinical and subclinical ED might be an important element in "brittle" diabetes, collaboration between diabetologists and ED specialists is warranted.…”

“…Because clinical and subclinical ED might be an important element in "brittle" diabetes, collaboration between diabetologists and ED specialists is warranted. Treatment of these cases is difficult (2,24).…”

“…The course of subclinical ED and ED-NOS in type 1 diabetic patients should be elucidated because these conditions are more frequent than AN and bulimia nervosa (2,23,25). In cases of brittle diabetes, a formal evaluation for ED might be helpful.…”

“…It is not stated whether this mortality is "excessive" or "expectable." Because controlled studies (4 -7) and a meta-analysis (2) indicate early and severe neurovascular complications in these patients, excess mortality is expectable. Furthermore, ED might lead to unstable or "brittle" diabetes, a condition with high mortality and a high frequency of diabetes complications (8).…”