Skip to main content
SpringerLink
Log in

Identification and Treatment of Eating Disorders in Women with Type 1 Diabetes Mellitus

  • Therapy In Practice
  • Published:
Treatments in Endocrinology

Abstract

A series of case reports in the early 1980s and prevalence studies in the 1990s highlighted the serious medical consequences of coexisting eating disorders and diabetes mellitus. Diabetes-specific treatment issues, such as the need to carefully monitor diet, exercise, and blood glucose, may contribute to the development of eating disorder symptoms among women with diabetes mellitus.

The attention to food portions and body weight that is part of routine diabetes mellitus management parallels the rigid thinking about food and body image found in women with eating disorders who do not have diabetes mellitus. Additionally, intensive insulin management of diabetes mellitus, the current standard of care, has been shown to be associated with bodyweight gain. Following from this, it may be that the very goals of state-of-the-art diabetes mellitus care increase the risk for developing an eating disorder. Once an eating disorder and recurrent insulin omission becomes entrenched, a pattern develops which is hard to break —one of chronic hyperglycemia, depressed mood, fear of bodyweight gain, and frustration with diabetes management.

Eating disorders predispose women with diabetes mellitus to many complex medical risks. For example, insulin omission and reduction, eating disorder symptoms unique to diabetes mellitus, are strongly associated with an increased risk of diabetic ketoacidosis and with microvascular complications of diabetes mellitus such as retinopathy. For this reason, it is critical that diabetes mellitus clinicians understand more about eating disorders so as to improve the likelihood of early detection, appropriate treatment, and prevention of acute and long-term medical complications within this high-risk group of women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I

Similar content being viewed by others

References

  1. Kahn CR, Weir GC. Joslin’s diabetes mellitus. 13th ed. Malvern: Lea & Febiger, 1994

    Google Scholar 

  2. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus: the Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329(14): 977–86

    Article  Google Scholar 

  3. Diabetes Control and Complications Trial Research Group. Weight gain associated with intensive therapy in the diabetes control and complications trial. Diabetes Care 1988; 11(7): 567–73

    Article  Google Scholar 

  4. Diabetes Control and Complications Trial Research Group. Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the diabetes control and complications trial. Diabetes Care 2001; 24(10): 1711–21

    Article  Google Scholar 

  5. Thompson CJ, Cummings JF, Chalmers J, et al. How have patients reacted to the implications of the DCCT? Diabetes Care 1996; 19(8): 876–9

    Article  PubMed  CAS  Google Scholar 

  6. Hogel J, Grabert M, Sorgo W, et al. Hemoglobin Alc and body mass index in children and adolescents with IDDM: an observational study from 1976-1995. Exp Clin Endocrinol Diabetes 2000; 108(2): 76–80

    Article  PubMed  CAS  Google Scholar 

  7. Cooper Z. The development and maintenance of eating disorders. In: Brownell KD, Fairburn CG, editors. Eating disorders and obesity: a comprehensive handbook. New York: Guilford, 1995: 199–206

    Google Scholar 

  8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  9. Hoek HW. The distribution of eating disorders. In: Brownell KD, Fairburn CG, editors. Eating disorders and obesity: a comprehensive handbook. New York: Guilford, 1995: 207–11

    Google Scholar 

  10. Walsh BT, Garner DM. Diagnostic issues. In: Garner DM, Garfinkle PE, editors. Handbook of treatment for eating disorders. New York: Guilford, 1997: 25–33

    Google Scholar 

  11. Jones JM, Lawson ML, Daneman D, et al. Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 2000; 320(7249): 1563–6

    Article  PubMed  CAS  Google Scholar 

  12. Daneman D, Olmsted M, Rydall A, et al. Eating disorders in young women with type 1 diabetes: prevalence, problems and prevention. Horm Res 1998; 50Suppl. 1: 79–86

    Article  PubMed  CAS  Google Scholar 

  13. Affenito SG, Adams CH. Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered. Nutr Rev 2000; 59(6): 179–82

    Google Scholar 

  14. Fairburn CG, Peveler RC, Davies B, et al. Eating disorders in young adults with insulin dependent diabetes mellitus: a controlled study. BMJ 1991; 303(6793): 17–20

    Article  PubMed  CAS  Google Scholar 

  15. Bryden KS, Neil A, Mayou RA, et al. Eating habits, body weight, and insulin misuse: a longitudinal study of teenagers and young adults with type 1 diabetes. Diabetes Care 1999; 22(12): 1956–60

    Article  PubMed  CAS  Google Scholar 

  16. Verrotti A, Catino M, De Luca FA, et al. Eating disorders in adolescents with type 1 diabetes mellitus. Acta Diabetol 1999; 36(1–2): 21–5

    Article  PubMed  CAS  Google Scholar 

  17. Rydall AC, Rodin GM, Olmsted MP, et al. Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 1997; 336(26): 1849–54

    Article  PubMed  CAS  Google Scholar 

  18. Biggs MM, Basco MR, Patterson G, et al. Insulin withholding for weight control in women with diabetes. Diabetes Care 1994; 17(10): 1186–9

    Article  PubMed  CAS  Google Scholar 

  19. Polansky WH, Anderson BJ, Lohrer PA, et al. Insulin omission in women with IDDM. Diabetes Care 1994; 17: 1178–85

    Article  Google Scholar 

  20. Wing RR, Nowalk MP, Marcus MD, et al. Subclinical eating disorders and glycemic control in adolescents with type I diabetes. Diabetes Care 1986; 9(2): 162–7

    Article  PubMed  CAS  Google Scholar 

  21. Rodin GM, Daneman D. Eating disorders and IDDM: a problematic association. Diabetes Care 1992; 15(10): 1402–12

    Article  PubMed  CAS  Google Scholar 

  22. American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 2001; 24Suppl. 1: S44–7

    Google Scholar 

  23. Striegel-Moore RH. Etiology of binge eating: a developmental perspective. In: Fairburn CG, Wilson GT, editors. Binge eating: nature, assessment, and treatment. New York: Guilford Press, 1993: 144–72

    Google Scholar 

  24. Polivy J, Herman CP. Dieting and binging. A causal analysis. Am Psychol 1985; 40(2): 193–201

    Article  PubMed  CAS  Google Scholar 

  25. Lustman PJ, Anderson RJ, Freedland KE, et al. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23(7): 934–42

    Article  PubMed  CAS  Google Scholar 

  26. Cox DJ, Irvine A, Gonder-Frederick L, et al. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care 1987; 10(5): 617–21

    Article  PubMed  CAS  Google Scholar 

  27. Goebel-Fabbri AE. Eating disorders in diabetes. In: Anderson BJ, Rubin RR, editors. Practical psychology for diabetes clinicians. 2nd ed. Alexandria (VA): American Diabetes Association, 2002

    Google Scholar 

  28. Garner DM, Olmsted MP. The eating disorders inventory (EDI) manual. Odessa (FL): Psychological Assessment Resources, 1984

    Google Scholar 

  29. Garner DM, Olmsted MP, Bohr Y, et al. The eating attitudes test: psychometric features and clinical correlates. Psychol Med 1982; 12: 871–8

    Article  PubMed  CAS  Google Scholar 

  30. Cooper Z, Cooper PJ, Fairburn CG. The validity of the eating disorder examination and its subscales. Br J Psychiatry 1989; 154: 807–12

    Article  PubMed  CAS  Google Scholar 

  31. LaGreca AM, Schwartz LT, Satin W. Eating patterns in young women with IDDM: another look [letter]. Diabetes Care 1987; 10: 659–60

    CAS  Google Scholar 

  32. Levine MD, Marcus MD. Women, diabetes and disordered eating. Diabetes Spectrum 1997; 10: 191–5

    Google Scholar 

  33. Antisdel JE, Chrisler JC. Comparison of eating attitudes and behaviors among adolescent and young women with type 1 diabetes mellitus and phenylketonuria. J Dev Behav Pediatr 2000; 21(2): 81–6

    Article  PubMed  CAS  Google Scholar 

  34. Mitchell JE, Pomeroy C, Adson, DE. Managing medical complications. In: Garner DM, Garfinkel PE, editors. Handbook for treatment of eating disorders. New York: Guilford, 1997: 383–93

    Google Scholar 

Download references

Acknowledgements

Dr Goebel-Fabbri gratefully acknowledges support for her work on this paper from the Harvard Scholars in Medicine — Priscilla White Fellowship and the Harvard Center for Excellence in Women’s Health.

Author information

Authors and Affiliations

  1. Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts, USA

    Ann E. Goebel-Fabbri, Janna Fikkan, Alexa Connell, Laura Vangsness & Barbara J. Anderson

Authors
  1. Ann E. Goebel-Fabbri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janna Fikkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexa Connell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Vangsness
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara J. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goebel-Fabbri, A.E., Fikkan, J., Connell, A. et al. Identification and Treatment of Eating Disorders in Women with Type 1 Diabetes Mellitus. Mol Diag Ther 1, 155–162 (2002). https://doi.org/10.2165/00024677-200201030-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00024677-200201030-00003

Keywords

Search

Navigation