By Jancin, Bruce
Clinical Psychiatry News , Vol. 34, No. 9
KEYSTONE, COLO. -- A high index of suspicion for eating disorders is warranted in adolescents and young adults with type 1 diabetes, Stephanie H. Gerken said at a conference on the management of diabetes in youth.
The largest studies suggest the prevalence of eating disorders (EDs) meeting Diagnostic and Statistical Manual, Fourth Edition, criteria is about 10% in adolescent girls with type 1 diabetes. Another 14% have subthreshold variants. Both rates are roughly twice those found in nondiabetic adolescent girls.
The most common unhealthy weight-control practice among diabetic teens is intentional omission of insulin to lose weight. Many diabetic patients with weight concerns quickly figure out that skipping insulin injections is an easier way to drop pounds than restricting food intake or bingeing and purging, explained Ms. Gerken, a diabetes educator and registered dietician at the International Diabetes Center, Park Nicollet Clinics, Minneapolis.
The elevated risk of eating disorders in association with type 1 diabetes is not limited to adolescents.
"We've been surprised at how many adults we see in their 30s and 40s who've been struggling for over 10 years with this and are finally wanting and accepting help," Ms. Gerken said at the conference sponsored by the University of Colorado and the Children's Diabetes Foundation, Denver.
She is part of a joint team composed of staff at the diabetes center and at the Park Nicollet Eating Disorders Institute--Minnesota's sole inpatient ED treatment facility. The unusual multidisciplinary program was created in recognition that this is a particularly challenging group of patients adept at exploiting the often conflicting management goals for the two diseases.
Patients with combined ED and type 1 diabetes experience poor metabolic control, with serious long-term consequences. British investigators who followed 87 type 1 diabetic females aged 11-25 years for 8-12 years found 26% had a clinical ED or evidence of bingeing and purging at baseline and/or follow-up. …