Potential Connection Established Between Eating Disorders, T1D

There is a clear and significant connection between eating disorders (EDs) and type 1 diabetes (T1D), particularly with binge eating and bulimia, according to the results of a study published in Endocrinology, Diabetes & Metabolism.¹

Previous meta-analyses from 2005 and 2013 indicate mixed results regarding the connection between EDs and T1D; the former found that bulimia nervosa is significantly associated with T1D, while the latter showed an insignificant association between EDs and T1D.

Individuals with T1D and evidence of EDs have increased health risks; the combination is associated with a variety of adverse short- and long-term physical consequences, compromised metabolic control, and a 3-fold increase in the risk of diabetic retinopathy, the investigators wrote. Given these potential adverse outcomes, the study sought to further analyze the association between T1D and EDs, in addition to the various subtypes of EDs. The authors also aimed to describe how disordered eating behaviors (DEBs) in patients with T1D could lead to adverse outcomes in the future.

In this study, a statistically significant association was seen between individuals with diabetes and a higher incidence of bulimia nervosa vs the control group | Image Credit: VectorMine - stock.adobe.com

Fourteen studies were ultimately included in the meta-analysis. In total, 9079 patients were included in the studies, with 1391 patients in the T1D group and 7688 participants in the control group, the investigators reported.

A statistically significant association between the diabetes group and a higher incidence of ED compared with the control group was found after the pooled analysis (risk ratio [RR], 2.47; 95% CI, 1.84-3.32; P < .00001), according to the investigators. Regarding anorexia nervosa in particular, the analysis did not show a statistically significant between the diabetes and control groups (RR, 3.27; 95% CI, 0.13-81.95; P = .47).

There was a statistically significant association between individuals with diabetes and a higher incidence of bulimia nervosa vs the control group (RR, 2.80; 95% CI, 1.18-6.65; P = .02). Additionally, a significant relationship was found between those with diabetes and the incidence of binge eating (RR, 1.53; 95% CI, 1.18-1.98; P = .001), the investigators found.

Interestingly, the investigators’ analysis did not indicate a statistically significant difference between the diabetes and control groups regarding the prevalence of a variety of DEBs. These include laxative use (RR, 1.85; 95% CI, 0.99-3.45; P = .06), diuretic misuse (RR, 0.76; 95% CI, 0.05-12.56; P = .85), and vomiting (RR, 0.97; 95% CI, 0.39-2.38; P = .94).

The only DEB to exhibit any significant association was insulin omission and misuse. There was an overall prevalence of 10.3% (95% CI, 8.1%-13.0%) in the study sample, and there was a significant association between the female patients and insulin omission, as well as increased insulin misuse, compared with the male patients, the investigators wrote.

The findings regarding DEBs echoed those of previous studies, which also found no significant associations but concerningly high percentages of participants with T1D who misused or skipped insulin doses, according to the investigators. One study in particular, from Schober et al, reported that almost 30% of participants with T1D intentionally manipulated their insulin doses, with females being most at risk.²

Given the strong associations found in their analysis, the investigators deemed it imperative to proactively screen and identify adolescents who may be at risk for EDs. Evidence-based tools such as questionnaires and surveys should be used to accurately determine whether a patient has EDs/DEBs, the investigators recommended.

“Early proactive screening is essential, and tailored, comprehensive interventions combining diabetes and ED components are recommended for this population, with referral to a specialised psychiatrist,” the investigators concluded.

References

1. Dean Y, Motawea K, Aslam M, et al. Association between type 1 diabetes mellitus and eating disorders: a systematic review and meta-analysis. Endocrinol Diabetes Metab. 2024;7(3):e473. doi:10.1002/edm2.473

2. Schober E, Wagner G, Berger G, et al. Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2011;12(7):627-631. doi:10.1111/j.1399-5448.2011.00759.x