Eating problems in adolescents with Type 1 diabetes: a systematic review with meta‐analysis

Young, V; Eiser, Christine; Johnson, Barbara; Brierley, S; Epton, Tracy; Elliott, Jackie; Heller, Simon

doi:10.1111/j.1464-5491.2012.03771.x

Cited by 324 publications

(321 citation statements)

References 38 publications

(87 reference statements)

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“…In studies from Jones et al (2) and Grylli et al (20), 10% and 11.5% of the investigated patients with T1DM had ED based on DSM-IV criteria. Recently, ED prevalence among adolescents with T1DM was estimated to 7.0% (35). In a metaanalysis of T1DM females, prevalence of AN was not significantly higher compared with nondiabetic control subjects; however, BN was reported significantly more often (5).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

et al. 2014

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OBJECTIVETo compare clinical characteristics and outcome of type 1 diabetes mellitus (T1DM) between patients with and without a clinically recognized eating disorder (ED). RESEARCH DESIGN AND METHODSA total of 52,215 T1DM patients aged 8 to <30 years from the prospective diabetes data acquisition system DPV were analyzed. A total of 467 patients had an additional diagnosis of ED according to DSM-IV criteria (anorexia nervosa [AN], n = 141 [female: 94.3%]; bulimia nervosa [BN], n = 62 [90.3%]; and EDs not otherwise specified, including binge-eating disorder [EDNOS], n = 264 [74.2%]). Groups were compared using multivariable regression. Cox proportional hazard ratios were calculated for the association between ED and retinopathy. RESULTSAfter adjustment for age, sex, and duration of diabetes, patients with ED revealed higher HbA 1c (no ED vs. AN, BN, or EDNOS, respectively: 8.29 6 0.01% [67.1 6 0.1 mmol/mol] vs. 8.61 6 0.15% [70.6 6 1.6 mmol/mol], 9.11 6 0.23% [76.1 6 2.5 mmol/mol], or 9.00 6 0.11% [74.9 6 1.2 mmol/mol]) and a higher rate of pathological insulin injection sites (48.4 vs. 64.3, 64.1, or 62.1%). Furthermore, ketoacidosis (5.7 6 0.1 vs. 12.1 6 2.1, 18.0 6 4.1, or 12.9 6 1.6 events per 100 person-years) and hospitalization (54.9 6 0.3 vs. 89.3 6 6.0, 132.0 6 12.7, or 91.0 6 4.4 per 100 person-years) were more common, and duration of hospital stay was longer (4.81 6 0.01 vs. 11.31 6 0.21, 18.05 6 0.48, or 8.44 6 0.13 days per year). All P values were <0.05. Patients with BN and EDNOS had a 2.5-fold (95% CI 1.3-4.8) and a 1.4-fold (0.8-2.3) higher risk for retinopathy, whereas AN patients had no increased risk (0.9 [95% CI 0.4-2.3]). CONCLUSIONSDiabetes health care professionals should be aware of comorbid EDs in pediatric/ young-adult T1DM patients. An ED diagnosis is associated with worse metabolic control and higher rates of diabetes complications.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

et al. 2014

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“…340 Disturbed eating behaviors, coupled with unhealthy weight control behaviors, have been associated with adverse glucose control. 338,341 Up to 50.4% of male and female adolescents with T1DM reported using weight control behaviors. 338 Insulin omission and insulin underdosing are the most serious weight control behaviors reported.…”

Section: Type 1 Diabetes Mellitusmentioning

confidence: 99%

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

Maahs¹,

Daniels²,

Ferranti³

et al. 2014

Circulation

158

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“…The interpretation of the reported prevalence of DEB and diabetes is difficult because there are no standardised diabetes-specific measures; however, it has been suggested that between 11.5% and 27.5% of adolescents with type 1 diabetes meet the diagnostic criteria for an ED, most commonly bulimia nervosa or binge eating disorder. 1,3 Up to 30% mismanage insulin to avoid weight gain or lose weight. 4 The most common risk factors for the development of an ED in the general population include young female, a history of dietary restraint and dieting, weight gain, low self-esteem, and family dysfunction.…”

Section: Eating Disorders and Diabetesmentioning

confidence: 99%

“…Almost 50 years later it is now well established that when compared with their non-diabetic peers, individuals with type 1 diabetes are at increased risk of developing disordered eating behaviours (DEBs) and EDs which are associated with poor glycaemic control. 1 Poor glycaemic control and its potentially life threatening impact on health, make it essential that diabetes health care teams are aware of the potential for disordered eating in conjunction with a preoccupation with weight and negative body image so that it can be recognised and treated early.…”

mentioning

confidence: 99%

Diabulimia: mental health condition or media hyperbole?

Shaban

2013

Practical Diabetes

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T ype 1 diabetes demands optimal control of a variety of metabolic parameters, most notably blood glucose. This is achieved through attention to food choice, portion size, insulin dose adjustment, exercise and other contributors to a healthy lifestyle. The consequences of long-term poor glycaemic control are wide ranging and potentially devastating. For some individuals this attention to food results in perceived restraint and restriction of choice, weight gain associated with insulin use and a sense of loss of control. The first reports of eating disorders (EDs) and diabetes emerged in the 1970s. Almost 50 years later it is now well established that when compared with their non-diabetic peers, individuals with type 1 diabetes are at increased risk of developing disordered eating behaviours (DEBs) and EDs which are associated with poor glycaemic control. 1 Poor glycaemic control and its potentially life threatening impact on health, make it essential that diabetes health care teams are aware of the potential for disordered eating in conjunction with a preoccupation with weight and negative body image so that it can be recognised and treated early. Eating disorders and diabetesThere are three main diagnoses of eating disorder: anorexia characterised by an obsessive fear of weight gain and severe restriction of dietary intake; bulimia characterised by binge eating followed by purging, usually vomiting or laxative abuse; and eating disorders not otherwise specified (EDNOS) characterised by the above symptoms but which do not meet the criteria for a diagnosis of a specific eating disorder. Although EDs occur in males (1 per 400) 2 they are most prevalent in teenage girls and young adult females (1 per 50). 2 The prevalence of atypical EDs is even more common and may not receive treatment. The interpretation of the reported prevalence of DEB and diabetes is difficult because there are no standardised diabetes-specific measures; however, it has been suggested that between 11.5% and 27.5% of adolescents with type 1 diabetes meet the diagnostic criteria for an ED, most commonly bulimia nervosa or binge eating disorder. 1,3 Up to 30% mismanage insulin to avoid weight gain or lose weight. 4 The most common risk factors for the development of an ED in the general population include young female, a history of dietary restraint and dieting, weight gain, low self-esteem, and family dysfunction. These risks are intensified by type 1 diabetes because the foundation stone for successful management of the condition is a focus on food. Diagnosis of type 1 diabetes frequently occurs around puberty when weight and body image concerns are very prominent and the individual is likely to have negative emotional reactions to the diagnosis and the tendency to weight gain following the initiation of insulin therapy. The core symptom dimension is a negative selfevaluation influenced by weight and perceived body shape. Mild eating disturbances can compromise metabolic control, and longitudinal studies report that these tend to be persistent r...

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Eating problems in adolescents with Type 1 diabetes: a systematic review with meta‐analysis

Abstract: Eating problems are common among this age group. Future work in populations with Type 1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended.

Cited by 324 publications

References 38 publications

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

Diabulimia: mental health condition or media hyperbole?

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