Eating disorders and type 1 diabetes

Abstract

As members of a Paediatric Diabetes Multidisciplinary Team, we have become increasingly concerned by the number of young people we are seeing who have Type 1 diabetes (T1D) and have developed, or are developing, complex relationships with food. Colleagues in other diabetes services have expressed similar concerns. In recent years a number of people who have T1D and are struggling with eating disorders have publicly shared their stories, notably in a widely viewed TV documentary (Hughes-Hallet, 2017) and also across social media platforms. This is still a relatively new area for both clinicians and researchers, and there is still much to be learnt about how to best prevent, assess and treat eating disorders in the context of T1D. We are therefore delighted to introduce this Special Issue of Clinical Child Psychology and Psychiatry, which brings together a range of informative and thought-provoking papers on this topic.Eating Disorders are characterised by "persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs health or psychosocial functioning" (APA, 2021). Eating disorders include conditions such as Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Other Specified Feeding Eating Disorder and Avoidance/Restrictive Food Intake Disorder. Eating disorders can be extremely serious, and have the highest rates of mortality across all mental health conditions (Arcalus et al., 2011).It is thought that eating disorders affect approximately 2-4% of the population at some point during their lifetime (Galmiche et al., 2019;Smink et al., 2012;Young et al., 2013). In addition, there are signs that the prevalence of eating disorders (the proportion of the population that meet the criteria for an eating disorder at a single point in time) may be increasing. A recent systematic review (Galmiche et al., 2019) found that the global prevalence of eating disorders had increased from 3.5% to 7.8% between 2000 and 2018. It is also thought that COVID-19 restrictions have led to a further rise in body image concerns (Robertson et al., 2021;Solmi et al., 2021). People living with T1D are twice as likely to present with an eating disorder as their peers (Young et al., 2013).Type 1 diabetes (T1D) is an autoimmune disease defined by insulin deficiency. When untreated or managed inappropriately, it can lead to Diabetic Ketoacidosis (DKA), a life-threatening condition. Treatment involves addressing this deficiency via exogenous insulin therapy, and modern diabetes treatments involve insulin injections or insulin pump therapy. Insulin doses depend on the amount of carbohydrate consumed and blood glucose levels (with consideration of exercise/activity levels and illness as relevant). Target ranges for blood glucose levels are set in order to minimise

Eating disorders in children and adolescents with type 1 diabetes mellitus

“…Poza wymienionymi zaburzeniami wyróżnić można również nieprawidłowe zachowania związane z jedzeniem takie jak wymuszanie wymiotów, ograniczanie/omijanie posiłków lub nadmierny wysiłek fizyczny, a w przypadku pacjentów z cukrzycą także redukcja dawek insuliny w celu obniżenia masy ciała. [6] Takie celowe ograniczanie dawek lub ilości podawanej insuliny w celu obniżenia masy ciała określane jest mianem "diabulimii". [7] Ze względu na rosnący problem występowania zaburzeń odżywiania w populacji [8] oraz faktu, iż zarówno zaburzenia odżywiania jak i cukrzyca typu 1 mogą stanowić zagrożenie dla życia [8], istotne jest poznanie przyczyn zwiększonej predyspozycji diabetyków do zaburzonej relacji z jedzeniem, wczesne rozpoznawanie schorzenia oraz skuteczna profilaktyka i leczenie.…”

“…Murphy i wsp. (2021) wymieniają także niewystarczającą edukację, niechęć do stosowania insuliny przy rówieśnikach, trudności z zaakceptowaniem diagnozy [6], a Colton i wsp. (2007) przyrost masy ciała podczas stosowania insulinoterapii [13].…”

“…Z kolei głównym kierunkiem rozwoju leczenia powinno być wzmacnianie współpracy zespołów zajmujących się zaburzeniami odżywiania i cukrzycą, podnoszenie świadomości i szkolenie personelu [18,25]. Kolejnym aspektem jest wprowadzanie takich strategii terapeutycznych, które umożliwią zdrowe zarządzanie glikemią, przy jednoczesnym promowaniu elastycznych i zrównoważonych zachowań żywieniowych [6].…”

Type 1 diabetes with an eating disorder

“…Although frameworks such as these can help to highlight unique features of T1DE, there is an argument that formal diagnostic criteria can unintentionally exclude some individuals from accessing support services if they do not meet criteria thresholds (Murphy and Pigott, 2021). An example of this might be an adolescent who omits insulin due to bullying at school rather than for the sole purpose of weight loss and body image concerns.…”

“…Diabetes specialists do not always have the skills and confidence to openly explore the mental health aspects of the illness and CAMHS do not necessarily have the knowledge to fully understand the physical implications (Murphy and Pigott, 2021). GPs, however, are skilled and practicised in managing both aspects of illness and are likely to be accessible and remain the ‘first port of call’ for a young person or their family with a medical concern.…”