Eating disorders in females with type 1 diabetes: an update of a meta‐analysis

Nielsen, Søren R.K.

doi:10.1002/erv.474

Cited by 109 publications

(101 citation statements)

References 40 publications

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“…In fact, if girls with DEB at baseline are included, half of the sample showed DEB at one or more assessments over the 5-year course of the study (15). The frequency of this behavior is of concern because of its potential association with impaired metabolic control and diabetes-related medical complications (2)(3)(4)6). In the current study the girls with DEB onset had poorer metabolic control coincident with the onset of DEB, indicating that even mild and relatively new disturbances in eating may have a significant impact.…”

Section: Predicting Onset Of Deb In Type 1 Diabetic Girlsmentioning

confidence: 99%

“…Both clinical and subthreshold eating disorders are more common in teenage girls and young women with type 1 diabetes than in their nondiabetic peers (2,3) and have more significant health consequences in this population related to compromised metabolic control (2,4) and increased risk of hospitalization and diabetes-related medical complications (5,6). Identification of risk factors for DEB in girls with diabetes is of practical utility because it may allow targeted interventions to be instituted to prevent or diminish the onset of DEB in this high-risk group.…”

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Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

et al. 2008

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OBJECTIVE -The purpose of this study was to identify predictors of the onset of disturbed eating behavior (DEB) in adolescent girls with type 1 diabetes.RESEARCH DESIGN AND METHODS -In this prospective study, participants completed the Children's Eating Disorder Examination interview and self-report measures at baseline and at four follow-up assessments over 5 years. Participants were 126 girls with type 1 diabetes, aged 9 -13 years at baseline. Of the 101 girls who did not have DEB at baseline, 45 developed DEB during the follow-up period; the 38 for whom data were available for the assessment before onset of DEB were compared with 38 age-matched girls who did not develop DEB. DEB was defined as dieting for weight control, binge eating, self-induced vomiting, or the use of diuretics, laxatives, insulin omission, or intense exercise for weight control.RESULTS -Logistic regression indicated that a model including BMI percentile, weight and shape concern, global and physical appearance-based self-worth, and depression was significantly associated with DEB onset ( 2 ϭ 46.0, 5 d.f., P Ͻ 0.0001) and accounted for 48.2% of the variance.CONCLUSIONS -Even though scores on the measures were within the published normal range, the onset of DEB was predicted by higher depression and weight and shape concerns and lower global and physical appearance-based self-worth as well as higher BMI percentile 1-2 years earlier compared with those not developing DEB. Early interventions focused on helping girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance may have protective value. Diabetes Care 31:1978-1982, 2008D isturbed eating behavior (DEB) tends to persist and worsen over time and is associated with the development of clinical eating disorders (1). Both clinical and subthreshold eating disorders are more common in teenage girls and young women with type 1 diabetes than in their nondiabetic peers (2,3) and have more significant health consequences in this population related to compromised metabolic control (2,4) and increased risk of hospitalization and diabetes-related medical complications (5,6). Identification of risk factors for DEB in girls with diabetes is of practical utility because it may allow targeted interventions to be instituted to prevent or diminish the onset of DEB in this high-risk group.In their recent review of risk factors for eating disorders, Striegel-Moore and Bulik (1) noted that internalization of an ideal of bodily thinness, body dissatisfaction, higher body weight, and dieting have consistently been identified as predictors of eating disturbance in longitudinal studies. Negative affect, including depressed mood and low self-esteem (7), and low perceived social support (8) have also been shown to predict subsequent disordered eating in some studies. However, evidence for the role of all of these risk factors has been limited. Although the mechanisms that account for the increased risk in girls with diabetes are not certain, diabetes has be...

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Section: Predicting Onset Of Deb In Type 1 Diabetic Girlsmentioning

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Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

et al. 2008

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“…This is an important mediator of the association of DEB and EDs with poorer metabolic control (5,6) and contributes to an increased risk of a range of short-term and long-term diabetes-related medical complications. These include abnormal lipid profiles (7), diabetic ketoacidosis (6), retinopathy (8), neuropathy (9), and nephropathy (10), as well as higher than expected mortality (11).…”

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Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

et al. 2015

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OBJECTIVEGirls and women with type 1 diabetes are at increased risk for developing eating disorders (EDs), and these disorders are associated with serious diabetes-related medical complications. This study describes the longitudinal course of disturbed eating behavior (DEB) and EDs in a cohort with type 1 diabetes. RESEARCH DESIGN AND METHODSA total of 126 girls with type 1 diabetes receiving care for diabetes at The Hospital for Sick Children in Toronto participated in a series of seven interview-based assessments of ED behavior and psychopathology over a 14-year period, beginning in late childhood. Survival analysis was used. RESULTSMean age was 11.8 6 1.5 years at time 1 and 23.7 6 2.1 years at time 7. At time 7, 32.4% (23/71) met the criteria for a current ED, and an additional 8.5% (6/71) had a subthreshold ED. Mean age at ED onset (full syndrome or below the threshold) was 22.6 years (95% CI 21.6-23.5), and the cumulative probability of onset was 60% by age 25 years. The average time between onset of ED and subsequent ED remission was 4.3 years (95% CI 3.1-5.5), and the cumulative probability of remission was 79% by 6 years after onset. The average time between remission of ED and subsequent recurrence was 6.5 years (95% CI 4.4-8.6), and the cumulative probability of recurrence was 53% by 6 years after remission. CONCLUSIONSIn this longitudinal study, EDs were common and persistent, and new onset of ED was documented well into adulthood. Further research regarding prevention and treatment for this vulnerable group is urgently needed.The prevalence, clinical characteristics, and medical consequences of disturbed eating behavior (DEB) and eating disorders (EDs) in individuals with type 1 diabetes has received increasing attention since case reports of this dangerous combination were first published in the 1980s (1,2). Although the specificity of this association was initially unclear, systematic research has demonstrated that teenage girls and women with type 1 diabetes are at significantly increased risk of DEB compared with their nondiabetic peers (3). Such DEB includes dieting, fasting, binge-eating, and a range of compensatory and purging behaviors that can directly interfere with optimal diabetes management. A slide set summarizing this article is available online.

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“…isturbed eating behavior (DEB), which includes subthreshold and full-syndrome eating disorders (EDs) as well as milder eating disturbances, is more common in girls and women with type 1 diabetes than in their nondiabetic peers (1,2). DEB is associated with poorer metabolic control (1,3) and increased hospitalizations and diabetesrelated medical complications (4 -7).…”

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Five-Year Prevalence and Persistence of Disturbed Eating Behavior and Eating Disorders in Girls With Type 1 Diabetes

et al. 2007

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Disturbed eating behavior (DEB), which includes subthreshold and full-syndrome eating disorders (EDs) as well as milder eating disturbances, is more common in girls and women with type 1 diabetes than in their nondiabetic peers (1,2). DEB is associated with poorer metabolic control (1,3) and increased hospitalizations and diabetesrelated medical complications (4 -7). At baseline of the present study, there were higher rates of DEB in girls with type 1 diabetes 9 -13 years of age than in a nondiabetic control group (8 vs. 1%) (8), and baseline DEB persisted in one-half of individuals 1 year later (9). The current brief report summarizes data from baseline to 5-year follow-up. for a description of methodology. Participants were classified as normal weight, overweight, or obese using the International Obesity Task Force cutoffs for children and adolescents (10), which extrapolate BMI values of 25 and 30 kg/m 2 into the pediatric age range. Rates of DEB and ED were organized by age (in years) at the time of each assessment (Table 1). Point prevalence was calculated as all "cases" of DEB in participants of a particular age/total number assessed at that age. Similar calculations were carried out for point prevalence of ED. Cumulative prevalence includes current and/or past DEB or ED. RESEARCH DESIGN AND METHODSRESULTS -A total of 126 girls participated at baseline (71.2% participation), 106 at 1 year (84.1%), 88 at 2 years (83.0%), 76 at 3 years (86.4%), and 98 at 5 years (77.8%). Girls who dropped out at 5 years were not more likely to have DEB at baseline than those who stayed in the study ( 2 ϭ 0.18, d.f. ϭ 1; P ϭ 0.9). Mean age was 11.8 Ϯ 1.5 years at baseline and 16.5 Ϯ 1.6 years at 5 years. Mean BMI was 20.1 Ϯ 3.2 kg/m 2 at baseline and 24.8 Ϯ 4.2 kg/m 2 at 5 years. Mean A1C was 8.3 Ϯ 1.1% at baseline and 8.5 Ϯ 1.1% at 5 years. At 5 years, 55.1% (54 of 98) of girls were classified as normal weight, 34.7% (34 of 98) as overweight, and 10.2% (10 of 98) as obese.At 5 years, 49.0% (48 of 98) of participants reported current DEB, 43.9% (43 of 98) active dietary restraint, 6.1% (6 of 98) binge-eating episodes, 3.1% (3 of 98) self-induced vomiting, 3.1% (3 of 98) insulin omission, and 25.5% (25 of 98) intense, excessive exercise for weight control. Thirteen participants (13.3%) met criteria for an ED: three girls had bulimia nervosa, three had an eating disorder not otherwise specified, and seven had a subthreshold ED. A1C was not higher in girls with DEB (8.7 vs. 8.4%; t ϭ 1.60, d.f. ϭ 91; P ϭ 0.11), although there was a trend for higher A1C in those with an ED (9.1 vs. 8.5%; t ϭ Ϫ1.75, d.f. ϭ 91; P ϭ 0.08). BMI was higher in those with DEB (26.1 vs. 23.5 kg/m 2 ; t ϭ Ϫ3.28, d.f. ϭ 96; P ϭ 0.001).Of 126 baseline participants, 64 (50.8%) reported DEB at one or more assessments. At least two assessments are available for 116 of the 126 at baseline (92.1%). Of these 116 girls, 26 (22.4%) had early DEB at baseline and/or at 1-year follow-up, and 90 (77.6%) did not. Of 26 girls, 24 (92.3%) with early DEB also reported DEB...

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Eating disorders in females with type 1 diabetes: an update of a meta‐analysis

Cited by 109 publications

References 40 publications

Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

Five-Year Prevalence and Persistence of Disturbed Eating Behavior and Eating Disorders in Girls With Type 1 Diabetes

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