Clinical

Watch for eating disorders in females with type 1 diabetes: study

ORLANDO (Reuters Health) - Physicians should pay close attention to the possibility of an eating disorder in their female patients with type 1 diabetes, researchers advised in a presentation at the 70th Scientific Sessions of the American Diabetes Association (ADA).

"While the literature suggests that up to 40% of females with type 1 diabetes also suffer from an eating disorder, the prevalence of eating disorders in this population is probably much higher," Dr. Kathryn Eckert, a pediatric endocrinologist in Reno, Nevada, told Reuters Health. "We believe that all females 10 years of age and older should be screened for possible eating disorders."

When they're first diagnosed, youngsters with diabetes have typically lost a significant amount of weight -- which they quickly regain once insulin therapy begins. Dr. Eckert, who works at a pediatric diabetes clinic and residential treatment center for eating disorders, noted that education for newly diagnosed diabetics emphasizes food portions and carbohydrate counting. As a result, patients quickly learn the relationship between food, insulin and weight.

These "revelations," coupled with life stressors and family dynamics, may trigger patterns of disordered eating in patients predisposed to this disorder.

Eating disorders can have insidious effects in type 1 patients, Dr. Eckert said. They'll typically have hemoglobin (Hb)A1C levels above 10%, and more frequent hospitalizations than patients without eating disorders. They also have a shorter time of onset and greater severity of diabetic retinopathy, neuropathy, and nephropathy.

Eating disorders in this population are typically defined by the misuse of insulin, which results in purging of calories through the kidneys. But they can also include features or full courses of anorexia nervosa, bulimia nervosa, binge eating disorder, and night-eating syndrome -- in which case patients will have "reasonable" HbA1c levels and a lower hospitalization rate than those who are misusing insulin to lose weight. Instead, these patients are likely to need insulin adjustments, and additional education and counseling sessions, "all of which can miss the mark and leave the eating disordered patient demoralized and isolated, with their eating disorder an ongoing and untreated secret."

Dr. Eckert said doctors should consider the possibility of an eating disorder in patients who have any of the following:

- Repeated admission to the hospital for diabetic ketoacidosis

- Frequent and erratic hypo- and hyperglycemia

- HbA1c inconsistent with logbook blood sugars

- Repeated flu-like symptoms

- Abnormal growth and puberty

- Irregular/absent menses

- Early onset of diabetes complications

She emphasized that while most of the literature to date has focused on female type 1 patients, eating disorders can occur in either gender and in type 2 diabetics as well.

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