Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options

Abstract

This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes, as compared to their peers without diabetes. Eating disorders and disordered eating behaviors – especially insulin omission – are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner.

Type 1 diabetes mellitus and eating disorders

“…If eating disorders are not recognised and treated early, the resulting poor metabolic control can lead to progression of diabetesrelated vascular complications. A disordered eating status was more predictive of diabetic retinopathy than the duration of diabetes [1,8].…”

“…This intense diet consciousness is imbibed at an early point in life and increases the patient's risk for disturbances in eating behaviours. Since both the entities T1DM and eating disorder affect largely the adolescent and young adult population, these disorders tend to coexist in this age group [1][2][3] .…”

I Should but I Can't: Controlled Motivation and Self-Efficacy Are Related to Disordered Eating Behaviors in Adolescents With Type 1 Diabetes

“…Adolescents with type 1 diabetes demonstrate higher prevalence of eating disorders and disordered eating behaviors (DEB) than their peers without diabetes (1–3). DEB are unhealthy weight management behaviors such as skipping meals or intentional vomiting that may not be severe or frequent enough to be classified as a diagnosable eating disorder (1,4).…”

“…DEB are unhealthy weight management behaviors such as skipping meals or intentional vomiting that may not be severe or frequent enough to be classified as a diagnosable eating disorder (1,4). In the context of type 1 diabetes, DEB may also include the use of insulin restriction or omission for weight loss, which can directly cause elevated blood glucose levels and hyperglycemic excursions (5).…”

“…In the context of type 1 diabetes, DEB may also include the use of insulin restriction or omission for weight loss, which can directly cause elevated blood glucose levels and hyperglycemic excursions (5). Consequently, even at subclinical levels, DEB can lead to adverse short-term (e.g., ketoacidosis) and long-term (e.g., neuropathy, retinopathy, clinical eating disorders) (1,3,6) health outcomes. Research is needed to elucidate risk factors for DEB to reduce adverse health consequences in this population.…”