Classification of Type 1 Diabetic Females With Bulimia Nervosa Into Subgroups According to Purging Behavior

Abstract

OBJECTIVE -To classify type 1 diabetic females with bulimia nervosa (BN) by type of inappropriate compensatory behavior in order to prevent weight gain (ICB) and to investigate the group differences.RESEACH DESIGN AND METHODS -Type 1 diabetic females with BN, diagnosed by structured diagnostic interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) criteria, were classified by type of ICB as follows: 1) only severe insulin omission as an ICB (BN-I) (n ϭ 22), 2) both severe insulin omission and self-induced vomiting and/or laxative abuse (BN-IP) (n ϭ 22), or 3) no insulin omission but another ICB (BN-NI) (n ϭ 11). The clinical characteristics of these three groups and a binge-eating disorder (BED) group (n ϭ 24) were compared.RESULTS -The BN-IP and BN-I groups had the highest HbA 1c levels. The BN-IP group had the highest rates of diabetic neuropathy, retinopathy, and nephropathy. The BN-NI group had the second highest rates of neuropathy and retinopathy. The BN-IP group had the highest frequencies of diabetes-and ketoacidosis-related hospital admissions, and the BN-I group had the second highest frequencies. The BN-NI group showed the highest scores on psychological tests related to depression, anxiety, eating disorder psychopathology, and perfectionism. The BN-NI group had the highest rate of history of visits to a psychiatrist, and the BN-IP group had the second highest history.CONCLUSIONS -Type 1 diabetic females with BN seem not to be homogenous and can be classified into three distinctive subgroups by type of ICB. Individuals with BN-IP had the most severe problems with both medical and psychological/behavioral aspects. Individuals with BN-NI manifested the highest psychological distress. The BN-I group had comparatively mild distress despite having the poorest metabolic control. Each BN group manifested more severe pathology than the BED group. Diabetes Care 25:1571-1575, 2002

The duration of severe insulin omission is the factor most closely associated with the microvascular complications of Type 1 diabetic females with clinical eating disorders

“…[7][8][9][10][11][12] However, no reports have given a detailed account of which behavioral factors related to eating disorders are the most associated Odds ratio for every one unit (year) increase of the variable. Ordered logistic regression was performed to estimate OR for retinopathy categorized to non, simple, or advanced retinopathy.…”

“…Therefore, for insulin omission as ICB of BN, we have defined severe insulin omission as omission/reduction of at least one-quarter of the prescribed insulin, mainly for the purpose of preventing weight gain. 8,20 The patient history of such disordered eating behaviors, especially severe insulin omission, is difficult to determine precisely, because of lapses in the patient's memory and/or refusal/resistance to admitting having done these behaviors. However, as our patient interview done in a long and supportive counseling session (outpatient counseling at first visit 20,21 ), our patients tend to report their history honestly.…”

“…At the first visit, the participants underwent a detailed clinical interview concerning the history of disordered eating behaviors such as the duration of binge eating, severe insulin omission, 3,7,8,[17][18][19] self-induced vomiting, and laxative abuse.…”

“…Previous research has reported that the prevalence of clinical eating disorders in young Type 1 diabetic females is 5-15% [1][2][3][4][5][6] and that Type 1 diabetic patients with eating disorders have a poorer metabolic control and a higher prevalence of diabetic-related complications than those without. [7][8][9][10][11][12] However, no reports have given a detailed account of which factors related to eating disorders are the most predictive of development of complications. Clarification of these factors would be useful in the management of these patients.…”

“…The majority were engaged in recurrent binge eating, either bulimia nervosa (BN) or binge-eating disorder (BED). 7,8 The primary difference between BN and BED was the regular use of an ''inappropriate compensatory behavior'' (ICB) to prevent weight gain in BN. 13 Our previous study showed that Type 1 diabetic females with BN had poorer metabolic control and higher rates of long-term complications than those with BED.…”