This article is more than 5 years old. Information may no longer be current.
Effects of eating disorders and diabetes
Poor dietary and glucose control increases a patient’s risk of diabetes complications and mortality.
Click Here to Manage Email Alerts
Eating disorders such as binge eating and bulimia have been shown to be more prevalent among individuals with type 1 and type 2 diabetes. Poorer dietary and glucose control result in a greater likelihood of diabetes complications and a higher mortality rate.
Providers should recognize that an eating disorder or disordered eating pattern may be preventing an individual from achieving optimal diabetes control. Assisting the patient in managing this disorder or making the appropriate referral may have as much or more impact than a medication adjustment in helping the patient achieve their metabolic goals.
|
|
Since the early 1980’s, it has been known that women with type 1 diabetes were especially at risk for disordered eating with a reported prevalence rate of 17% to 35%. Insulin restriction or omission is common in women with type 1 diabetes. This is sometimes known as “renal bulimia.”
Findings from a recent 11-year follow-up study reported in Diabetes Care showed that of the 234 women, 30% reported insulin restriction at baseline. At the end of the reporting period, 26 women had died. Those who reported insulin restriction had a lower mean age at death and had a higher incidence of nephropathy and foot problems. The researchers noted that “factors associated with type 1 diabetes treatment, such as careful attention to food portions and choices, regular exercise, regular blood glucose monitoring and treatment of hypoglycemia may contribute to eating and weight concerns in this population and may predispose the individual to develop specific disordered eating.” Weight gain is a common adverse effect of insulin treatment. One recommendation was that identifying the individual who may be restricting insulin can be found by a single screening item i.e. “I take less insulin than I should.” Their recommendation was that using this question may help identify those at risk.
Binge eating disorder and night eating syndrome are common in those who are overweight or obese and are more commonly seen in people with type 2 diabetes. The prevalence of binge eating disorder in people with diabetes is reported to range from 2.5% to 25%, with a higher rate in women than men. There have been few studies regarding night eating syndrome and diabetes. However, one study reported a prevalence of 9.7%. The rate in obesity clinics is reported to be between 9% and 14%. In a study published in Obesity, night eating syndrome was associated with a higher HbA1c, more complications and a higher risk for obesity.
Up to 35% of our patients may be affected by disordered eating. As providers, we must screen patients and provide the appropriate referral. If a patient is not achieving optimal glucose control, one must ask what else may be preventing the achievement of optimal metabolic control. Ask questions regarding dietary and medication management such as:
- Do you get up during the night and eat?
- How often does this occur?
- What do you eat in the evening?
- Do you ever skip your insulin or take less than you should?
Rather than automatically adjusting the medication or raising the insulin dose, one must ask what is happening with the individual’s calories in the evening and during the night or if the medication has been missed or altered.
For many, a referral to a dietitian, diabetes educator and/or a mental health expert should be considered for evaluation, management and treatment of the disordered eating or eating disorder. Education about diabetes and self management may help patients understand the interrelationship of the eating pattern and diabetes control. Psychotherapy and psychopharmatherapeutics may be necessary to alter the disordered eating pattern. Eating disorders significantly impact many individuals with diabetes and their metabolic control and ultimately mortality and morbidity.
For more information:
- Allison KC, Crow SJ, Reeves RR, et al. Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity. 2007.15:1287-1293.
- Goebel-Fabbri AE, Fikkan J, Franko DL, et al. Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care. 2008;31:415-419.
- O’Reardon JP, Ringel BL, Dinges DF, et al. Circadian eating and sleeping patterns in the night eating syndrome. Obesity Res. 2004;12:1789-1796.
Belinda P. Childs, ARNP, MN, CDE, BC-ADM, is a Diabetes Clinical Nurse Specialist at Mid-America Diabetes Associates, Pa.