Women with insulin-dependent diabetes mellitus (IDDM) complicated by eating disorders are at risk for exacerbated alterations in lipid metabolism

Abstract

Objective: To examine lipid parameters that are affected in women with insulin-dependent diabetes mellitus (IDDM) who engaged in disordered eating behaviours. Design: Randomized, unmatched. Setting: Tertiary care. Subjects: Ninety women (18±46 y) with IDDM. Interventions: Classi®cation of subjects based on severity of eating disorder: clinical (n 14), subclinical (n 13) and control (n 63). Blood was analysed for glycosylated haemoglobin (HbA 1c ) and serum for triglycerides and cholesterol. Carotenoid and tocopherol concentrations were analysed by high performance liquid chromatography (HPLC). Dietary intake was assessed by the National Cancer Institute food frequency questionnaire. Results: HbA 1c was signi®cantly increased im women demonstrating clinical and subclinical symptoms compared to control (10.4 AE 2.6, 10.0 AE 1.5 and 8.3 AE 1.6%, respectively, P`0.05). Triglyceride concentrations were signi®cantly increased in women with subclinical eating disorders compared to controls. In women who intentionally omitted or reduced insulin, triglyceride cholesterol and HbA 1c were signi®cantly increased compared to controls. Women with IDDM and eating disorders who exhibited bulimic behaviours consumed signi®cantly more energy, total fat and cholesterol compared to controls and women with eating disorders who were restrained eaters. Conclusion: While IDDM is known to perturb lipid metabolism, these data demonstrate that eating disorders, in combination with IDDM, results in additional alterations in lipid metabolism.

Lipoprotein metabolism in patients with anorexia nervosa: a case–control study investigating the mechanisms leading to hypercholesterolaemia

“…As AN-B eat foods rich in carbohydrate and fat (and thus rich in Chol) during the binge episodes, this could provide a further contribution to the higher Chol concentration seen in these subjects (Zoppi et al 1993;Sullivan et al 1998). Other studies have also suggested a relationship between this bulimic behaviour and hypercholesterolaemia (Crisp et al 1967;Affenito et al 1997;Case et al 1999). It could be argued that purging does not lead to absorption of the food consumed, but it has been shown previously that a substantial amount of energy is absorbed despite vomiting (Kaye et al 1993).…”

Disordered Eating Behavior in Individuals With Diabetes

“…The BULIT-R DSED, and EDI-3 were examined by the authors, a psychologist diabetes educator, and a psychologist with type 1 diabetes to identify questions that could be answered affirmatively in the context of diabetes self-management behaviors. “Do you feel you have control over the amount of food you consume?” and “I eat a lot of food when I'm not even hungry” are BULIT-R questions (used in studies by Affenito et al [17,18]) that directly relate to the diabetes care regimen: the former by prescription of dietary restraint and the latter by use of exogenous insulin. A later question, “I feel that food controls my life,” could be endorsed by any individual with diabetes.…”

“…More recent cross-sectional studies have demonstrated a positive association between elevated A1C and diagnosable eating disorders (2), subclinical DEB (8), and intentional insulin omission (1). The presence of diagnosable eating disorders and behavior categorized as subclinical DEB has been associated with increases in retinopathy (15), neuropathy (16), transient lipid abnormalities (17), hospitalizations for diabetic ketoacidosis (6), and poor short-term metabolic control (1,6,8,18). Studies assessing the association of DEB and eating disorders with long-term metabolic control have produced mixed results (6,19–22).…”

Eating Disorders and Diabetes: Introduction and Overview

“…31 Each of these can independently increase the risk of long-term diabetes-related complications, affecting multiple body systems.…”