Eating Disorders in Diabetes Mellitus
GARY M. RODIN
Type 1 diabetes mellitus is a common metabolic disorder in which there is impaired glucose utilization due to deficiency of insulin secretion by the pancreas. Its treatment involves multiple, daily insulin injections, regular monitoring of blood sugars, and restriction in the type and timing of food intake in order to normalize blood sugars. The latter diminishes short-term complications of diabetes, such as ketoacidosis, and long-term microvascular complications affecting the kidney, retina, heart, and peripheral blood vessels.
Eating disorders may occur in young women with type 1 diabetes on a coincidental basis, since both are relatively common conditions in this age group. Whether there is a more specific link between the two conditions is controversial, since some studies have reported negative findings, while others have found an increase in risk. Jones and colleagues recently conducted a large, case-controlled multisite study in which the prevalence of eating disorders in 356 girls age 12–19 years with type 1 diabetes was compared to that in 1,098 matched control subjects. Eating disorders that met DSM-IV diagnostic criteria for bulimia nervosa or eating disorders not otherwise specified (“atypical eating disorders”— see Chapter 30) were more than twice as common in subjects with diabetes as in controls (10% vs. 4%) and subthreshold states were also almost twice as common (14% vs. 8%).
Eating disorders in which there is binge eating and insulin omission are associated with elevated blood sugars and more frequent episodes of ketoacidosis. In a 4-year follow-up study of 91 girls age 12–19 years, Rydall and colleagues demonstrated that disordered