Eating Disorders and Disordered Eating Symptoms in Adolescents with Type 1 Diabetes

Abstract

Eating problems in adolescents with type 1 diabetes (T1D) can be divided into two groups. The first includes the diagnosed eating disorders (EDs), i.e., diseases specifically identified by defined signs and symptoms for which a degree of severity has been established, such as anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, and rumination. The second is the group of disordered eating symptoms (DES), which include behaviors such as dieting for weight loss, binge eating, self-induced vomiting, excessive exercise, and laxative or diuretic use; these behaviors cannot be categorized as complete diseases, and, although apparently mild, they must be closely evaluated because they can evolve into true EDs. In this review, present knowledge about the clinical relevance of EDs and DES and the possible preventive and therapeutic measures used to reduce their impact on the course of T1D will be discussed. As adolescents with diabetes are at higher risk of eating disturbances and consequently for higher rates of disease complications, care providers should pay attention to clinical warning signs that raise suspicion of disturbed eating to refer these patients early to an expert in nutrition and mental health disorders. To ensure the best care for adolescents with T1D, diabetes teams should be multidisciplinary and include a pediatric diabetologist, a skilled nurse, a dietician, and a psychologist.

Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry

“…Nevertheless, in accordance with the available evidence, inadequate diabetes control leading to chronic hyperglycaemia is likely associated with energy loss via glucosuria and subsequent weight reduction, spontaneous reduction of food intake promoted by ketoacidosis condition, and increased energy expenditure due to increased protein turnover and gluconeogenesis . The high HbA1c found in subjects with a high BMI‐SDS may be due to chronic positive energy balance promoted by inappropriate dietary behavior and eating disorders accompanied by inadequate insulin treatment, which are more common in adolescents than in younger children …”

“…58 The high HbA1c found in subjects with a high BMI-SDS may be due to chronic positive energy balance promoted by inappropriate dietary behavior and eating disorders accompanied by inadequate insulin treatment, which are more common in adolescents than in younger children. 36,59,60 The strengths of this study were: the large sample size, a worldwide dataset, and the SWEET data quality control. Weaknesses include the fact that the SWEET registry is not population-based and the researchers did not have access to subjects' ethnic backgrounds, nutritional habits, data on adjunctive therapies, different insulin regimens used, or physical activity history.…”

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

“…In eating disorders, we also found elevated rates associated with insulin-manipulation-which is already known from numerous previous studies. [20][21][22] What our study adds is that for the first time we could reveal that patients with T1D and eating disorders not only with underdose insulin for weight control purposes-but also overdose it to enable uncontrolled eating and binge eating. Interestingly, we did not find under-or overdosing associated to specific psychiatric disorders.…”

“…In a recent study, Cooper et al reported a 2.3 times higher risk for specific diagnoses such as anxiety, eating‐, mood‐, personality, and behavior disorders in young patients with T1D. The prevalence of depression is estimated to be 10% to 26% in T1D vs 4.7% to 6.2% in somatically healthy children and adolescents, of anxiety disorders it is 9% to 19% in T1D vs 3.8% to 7.4% and in eating disorders it is also elevated to 7% to 11.5% in T1D vs 2.8% in the general population. However, there are also studies showing no increased rates of psychiatric diagnoses .…”

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes

“…It is important that insulin adjustments by the Diabetes team do not support binge eating or food avoidance behaviors. Supervision of insulin doses and family‐based interventions are helpful strategies in treatment of disordered eating . More research is needed for interventions to prevent and treat disordered eating in diabetes.…”