Eating disorder symptoms affect 24% of patients with insulin-dependent diabetes

Key takeaways:

• Eating disorder symptoms were more common in women and girls than men and boys.
• The prevalence of eating disorder symptoms in the studies reviewed was associated with what screening tool was used.

Eating disorder symptoms and insulin omission appeared prevalent among patients with insulin-dependent diabetes, with more women and girls presenting with eating disorder symptoms, according to data published in Eating Behaviors.

Researchers observed this finding across age groups in their population, which included patients aged 16 years and older.

“Eating disorder symptoms are often thought to affect adolescents and young adults,” Pia E. Niemelä, a doctoral researcher at the University of Eastern Finland, said in a press release related to the study. “However, our meta-analysis shows that adults, too, suffer from eating disorder symptoms, which is why it is important to learn to identify patients with eating disorders.”

Patients with concurrent type 1 diabetes and an eating disorder have increased risk for diabetic complications, hospitalization and mortality compared with such patients without an eating disorder. This makes early identification and psychiatric and nutritional treatment crucial, the researchers wrote.

Aims, methods

Niemelä and colleagues primarily aimed to examine how common eating disorder symptoms are among patients aged 16 years and older with insulin-dependent type 1 or type 2 diabetes.

To accomplish this, they performed a systematic review and meta-analysis of studies that focused on adult and adolescent populations with insulin-dependent diabetes that reported the prevalence of eating disorder symptoms. They searched PubMed, Embase, Scopus, PsycINFO and CINAHL databases, identifying 45 studies that they included in the main meta-analysis.

Overall, these studies comprised 11,592 individuals and 2,521 cases of disordered eating. Notably, 10 studies included women and girls only.

The Diabetes Eating Problem Survey-Revised (DEPS-R) was used in 20 studies, making it the most common questionnaire used. Other screening tools that appeared in more than one study included Eating Attitudes Test- 26 and -40, Eating Disorder Examination Questionnaire and The Eating Disorder Inventory, among others.

Results

Using a random effects model, the researchers concluded that the overall prevalence of eating disorder symptoms was 24% (95% CI, 0.21–0.28).

Further, the type of disordered eating assessment tools used in each study were significantly associated with the prevalence rates (P ˂ .0001). For example, the pooled prevalence of eating disorder symptoms in studies that used DEPS-R was 27% (95% CI, 0.24–0.31).

Next, researchers evaluated the role of gender in the likelihood of eating disorder symptoms. They found that the prevalence of eating disorder symptoms was significantly higher in studies that included more than 58% women and girls, at 30% (95% CI, 0.26–0.34), compared with 18% (95% Cl, 0.14–0.22) in studies with a smaller proportion of women and girls (P = .0003).

The prevalence of eating disorder symptoms among patents with insulin-dependent diabetes also varied by country. The data showed that the pooled prevalence was highest in South America at 46% (95% CI, 0.41–0.51) and lowest in Asia at 13% (95% CI, 0.1–0.17).

As a secondary aim, the researchers investigated how prevalent insulin omission is among adult patients with type 1 diabetes in 13 of the studies, involving 2,210 patients and 531 cases, finding a pooled prevalence of insulin omission of 21% (95% CI, 0.13–0.33).

This prevalence of insulin omission — a unique form of disordered eating that involves intentionally skipping insulin doses to increase glucose secretion through the urine, leading to weight loss — is “concerning,” according to the researchers.

“Intentional skipping or restriction of insulin doses will lead to weight loss, but this also maintains high blood glucose, throwing the management of diabetes off balance,” Niemelä said.

Improving clinical outcomes

Niemelä and colleagues noted some study limitations, including the high proportion of true heterogeneity across the original studies. Further, they acknowledged DEPS-R-related limitations, such as its lack of validation against a measure of disordered eating, and they recommended additional validation studies.

But, overall, they stressed that their results showed that one-fourth of adults with insulin-dependent diabetes have eating disorder symptoms. They hope that future research will help to raise the consciousness of health care professionals, who may fail to sympathize with the psychosocial effects and emotional issues that arise due to insulin-dependent diabetes.

“Understanding the clinical picture and its prevalence is the first step in developing treatment and care pathways,” Niemelä said in the release.

Reference:

• Eating disorder symptoms are surprisingly common in people with insulin-dependent diabetes. https://medicalxpress.com/news/2024-05-disorder-symptoms-common-people-insulin.html. Published May 5, 2024. Accessed June 24, 2024.