Disturbed eating behaviors and eating disorders in type 1 diabetes: Clinical significance and treatment recommendations

OBJECTIVE To ascertain the association and co-aggregation of eating disorders and childhood-onset type 1 diabetes in families. RESEARCH DESIGN AND METHODS Using population samples from national registers in Sweden (n= 2 517 277) and Demark (n= 1 825 920) we investigated the within-individual association between type 1 diabetes and EDs, and their familial co-aggregation among full siblings, half-siblings, full cousins, and half-cousins. Based on clinical diagnoses we classified eating disorders (EDs) into: any eating disorder (AED), anorexia nervosa and atypical anorexia nervosa (AN), and other eating disorder (OED). Associations were determined with hazard ratios (HR) with confidence intervals (CI) from Cox regressions. RESULTS <pre>Swedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an ED diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80 – 2.27], AN 1.63 [1.36 – 1.96], OED 2.34 [2.07 – 2.63]; Denmark: AED 2.19 [1.84 – 2.61], AN 1.78 [1.36 – 2.33], OED 2.65 [2.20 – 3.21]). We also meta-analyzed the results: AED 2.07 [1.88 – 2.28], AN 1.68 [1.44 – 1.95], OED 2.44 [2.17 – 2.72]. There was an increased risk of receiving an ED diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07 – 1.46], AN 1.28 [1.04 – 1.57], OED 1.28 [1.07 – 1.52]), these results were non-significant in the Danish cohort.</pre> CONCLUSION Patients with 1 diabetes are at a higher risk of subsequent EDs; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and ED diagnosis. Diabetes healthcare teams should be vigilant for disordered eating behaviors in children and adolescents with type 1 diabetes.

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Eating Disorders and Type 1 Diabetes: a perspective

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530321666211109152353 ◽

2021 ◽

Vol 21 ◽

Author(s):

Simonetta Marucci ◽

Giulia De Iaco ◽

Giuseppe Lisco ◽

Francesco Mariano ◽

Vito Angelo Giagulli ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Management Strategy ◽

Eating Behaviors ◽

Psychosocial Issues ◽

Disordered Eating Behaviors ◽

Clinical Complexity ◽

Poor Outcomes ◽

The Relationship

: Patients with type 1 diabetes (T1D) are at risk of clinical eating disorders (EDs) and disordered eating behaviors (DEBs) than the general population. This burden is related mainly to diabetes-related physical and psychosocial issues especially beginning during childhood. DEBs must be investigated carefully and promptly managed in case of suspicion, as they can evolve into severe clinical EDs over time and are strictly related to poor outcomes. The significant number of scientific articles dealing with the relationship between T1D and DEBs or EDs confirms the complexity of these problems and the difficulties in diagnosis and treatment. This paper examined current scientific literature related to this topic, emphasizing the epidemiological and clinical complexity of the phenomenon and briefly summarizing EDBs management strategy in T1D patients.

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Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis

Diagnostics ◽

10.3390/diagnostics10121044 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1044

Author(s):

Valeria Calcaterra ◽

Chiara Mazzoni ◽

Donatella Ballardini ◽

Elena Tomba ◽

Gian Vincenzo Zuccotti ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Eating Behaviors ◽

Diabetes Management ◽

Early Recognition ◽

Screening Tools ◽

Effective Prevention ◽

Eating Problem ◽

R Factors

Background: Disordered eating behaviors (DEBs), including diagnosable eating disorders, are quite common and can interfere with optimal type 1 diabetes (T1DM) management. We explored DEBs prevalence in youth with T1DM, proposing news diagnostic subscales, to represent the clinical dimensions associated with feeding and eating disorders (ED); Methods: additionally to SCOFF questionnaire and Diabetes Eating Problem Survey–Revised (DEPS-R), four subscales combined from the original DEPS-R questionnaire were administered to 40 youths with T1DM (15.0 ± 2.6); Results: females showed higher scores than males in DEPS-R original factor 2 (“preoccupations with thinness/weight”, p = 0.024) and in DEPS-R proposed “restriction” factor (p = 0.009). SCOFF scores was correlated with original DEPS-R factors 1 (“maladaptive eating habits”) and 2 (p < 0.001) and with the newly proposed DEPS-R factors: restriction, disinhibition, compensatory behaviors, diabetes management (all p < 0.02). Diabetes management was the only factor related to glycated hemoglobin level (p = 0.006). Patients with high DEPS-R score (≥20) scored higher than patients with low (<20) DEPS-R score in DEPS-R original factors 1 (p < 0.001) and 2 (p = 0.002) as well as in the proposed factors including restriction, disinhibition, diabetes management (all p < 0.02); Conclusions: the complicated nature of DEBs calls for the development target specific questionnaires to be used as screening tools to detect cases of DEBs and exclude non cases. Early recognition of DEBs in adolescents with T1DM is essential for effective prevention and successful treatment.

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Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

Diabetes Care ◽

10.2337/dc19-0445 ◽

2019 ◽

Vol 42 (9) ◽

pp. 1637-1644 ◽

Cited By ~ 2

Author(s):

Koen Luyckx ◽

Margaux Verschueren ◽

Nina Palmeroni ◽

Eveline R. Goethals ◽

Ilse Weets ◽

...

Keyword(s):

Type 1 Diabetes ◽

Prospective Study ◽

Emerging Adults ◽

Eating Behaviors ◽

Disturbed Eating ◽

One Year

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Disturbed eating behaviors in adolescents with type 1 diabetes. How to screen for yellow flags in clinical practice?

Pediatric Diabetes ◽

10.1111/pedi.12400 ◽

2016 ◽

Vol 18 (5) ◽

pp. 376-383 ◽

Cited By ~ 6

Author(s):

Minke MA Eilander ◽

Maartje de Wit ◽

Joost Rotteveel ◽

Henk Jan Aanstoot ◽

Willie M Bakker-van Waarde ◽

...

Keyword(s):

Type 1 Diabetes ◽

Clinical Practice ◽

Eating Behaviors ◽

Disturbed Eating ◽

Yellow Flags

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Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden

10.2337/figshare.14040212.v1 ◽

2021 ◽

Author(s):

Ashley E. Tate ◽

Shengxin Liu ◽

Ruyue Zhang ◽

Zeynep Yilmaz ◽

Janne T. Larsen ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Behaviors ◽

Diabetes Diagnosis ◽

Disordered Eating Behaviors ◽

Increased Risk ◽

Clinical Diagnoses

OBJECTIVE To ascertain the association and co-aggregation of eating disorders and childhood-onset type 1 diabetes in families. RESEARCH DESIGN AND METHODS Using population samples from national registers in Sweden (n= 2 517 277) and Demark (n= 1 825 920) we investigated the within-individual association between type 1 diabetes and EDs, and their familial co-aggregation among full siblings, half-siblings, full cousins, and half-cousins. Based on clinical diagnoses we classified eating disorders (EDs) into: any eating disorder (AED), anorexia nervosa and atypical anorexia nervosa (AN), and other eating disorder (OED). Associations were determined with hazard ratios (HR) with confidence intervals (CI) from Cox regressions. RESULTS <pre>Swedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an ED diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80 – 2.27], AN 1.63 [1.36 – 1.96], OED 2.34 [2.07 – 2.63]; Denmark: AED 2.19 [1.84 – 2.61], AN 1.78 [1.36 – 2.33], OED 2.65 [2.20 – 3.21]). We also meta-analyzed the results: AED 2.07 [1.88 – 2.28], AN 1.68 [1.44 – 1.95], OED 2.44 [2.17 – 2.72]. There was an increased risk of receiving an ED diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07 – 1.46], AN 1.28 [1.04 – 1.57], OED 1.28 [1.07 – 1.52]), these results were non-significant in the Danish cohort.</pre> CONCLUSION Patients with 1 diabetes are at a higher risk of subsequent EDs; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and ED diagnosis. Diabetes healthcare teams should be vigilant for disordered eating behaviors in children and adolescents with type 1 diabetes.

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Disturbed Eating Behavior and Eating Disorders in Preteen and Early Teenage Girls With Type 1 Diabetes: A case-controlled study

Diabetes Care ◽

10.2337/diacare.27.7.1654 ◽

2004 ◽

Vol 27 (7) ◽

pp. 1654-1659 ◽

Cited By ~ 119

Author(s):

P. Colton ◽

M. Olmsted ◽

D. Daneman ◽

A. Rydall ◽

G. Rodin

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Eating Behavior ◽

Controlled Study ◽

Teenage Girls ◽

Disturbed Eating

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Disordered Eating Behaviors in Youth With Type 1 Diabetes

The Diabetes Educator ◽

10.1177/0145721705279049 ◽

2005 ◽

Vol 31 (4) ◽

pp. 572-583 ◽

Cited By ~ 41

Author(s):

Sarah Dion Kelly ◽

Carol J. Howe ◽

Jennifer Paige Hendler ◽

Terri H. Lipman

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Disordered Eating ◽

Eating Behaviors ◽

Treatment Options ◽

Screening Tools ◽

Disordered Eating Behaviors ◽

Chronic Hyperglycemia ◽

Increased Risk

Eating disorders are a significant health problem for many adolescents and are described as occurring along a spectrum of symptoms including disordered eating behaviors and clinical eating disorders. Poor self-esteem and body image, intense fear of gaining weight or refusal to maintain weight, and purging unwanted calories are clinical features of some eating disorders. Type 1 diabetes is a chronic illness with marked insulin deficiency. Chronic hyperglycemia creates a state of glucosuria with subsequent weight loss. Diabetes treatment focuses on intensive daily management of blood glucose by balancing insulin, food intake, and physical activity. Insulin omission offers an easy method for the purging of unwanted calories. The combination of these 2 illnesses is potentially deadly and also leads to an increased risk of poor diabetes outcomes. This includes poor metabolic control (measured by elevated hemoglobin A1C), increased risk of diabetic ketoacidosis, and microvascular complications such as retinopathy and nephropathy. Diabetes clinicians should be aware of the potential warning signs in an adolescent with diabetes as well as assessment and treatment options for eating disorders with concomitant type 1 diabetes. This article reviews the available data on the prevalence, screening tools, assessment guidelines, and treatment options for eating disorders in youth with type 1 diabetes.

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