Skip to main content

Pathological eating behaviours and risk of retinopathy in diabetes: a systematic review and meta-analysis

Abstract

Background

Diabetes mellitus can cause several long-term macrovascular and microvascular complications including nephropathy, neuropathy, and retinopathy (DR). Several studies have reported positive associations between eating pathologies and DR; however, these studies have not been aggregated and sub-grouped into type of pathological eating behaviour, and the differences in risk according to type of eating behaviour is unknown. The aim of this review, therefore, was to aggregate risks of DR in populations with and without pathological eating behaviours, stratified according to eating behaviour.

Methods

A systematic review and meta-analysis was conducted. Major databases and grey literature were search from inception until 1/6/2021. Studies reporting the prevalence of pathological eating behaviours (against a control group with no pathological eating behaviours) in diabetic people with and without DR were included. Odds ratios were calculated from primary data.

Results

Seven studies with eight independent outcomes with a total of 1162 participants were included. The odds ratio of DR in the total pooled analysis was 2.94 (95%CI 1.86–4.64; p = <0.001; I2 = 29.59). Two types of eating behaviour yielded enough data for sub-group analysis. Eating disorder not otherwise specified yielded an odds ratio of 2.73 (95%CI 1.81–4.10; p = <0.001; I2 = 0.00), and binge eating disorder yielded an non-significant odds ratio of 0.92 (95%CI 0.31–2.77; p = 0.887;I2 = 0.00).

Discussion

The likelihood of DR increases almost three times in the presence of pathological eating behaviours. More studies are required to confirm this in clinical populations stratified by eating disorder. Practitioners working with people with diabetes should closely monitor eating behaviours to preclude this risk.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Data availability

All data from this study are available from pre-published papers.

References

  1. diabetes.co.uk. Dry mouth and diabetes. 2020. https://www.diabetes.co.uk/diabetes-complications/dry-mouth.html. Accessed 28 Jul 2020.

  2. Hirai FE, Tielsch JM, Klein BE, Klein R. Ten-year change in vision-related quality of life in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy. Ophthalmology. 2011;118:353–8.

    Article  Google Scholar 

  3. Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev. 2013;93:137–88. https://doi.org/10.1152/physrev.00045.2011.

    CAS  Article  PubMed  Google Scholar 

  4. Mathur R, Bhaskaran K, Edwards E, et al. Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the clinical practice research datalink 2004–2014. BMJ Open. 2017;7:e014444. https://doi.org/10.1136/bmjopen-2016-014444.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ren C, Liu W, Li J, et al. Physical activity and risk of diabetic retinopathy: a systematic review and meta-analysis. Acta Diabetol. 2019;56:823–37.

    Article  Google Scholar 

  6. Kim TK, Won JY, Shin JA, et al. The association of metabolic syndrome with diabetic retinopathy: the Korean national health and nutrition examination survey 2008–2012. PLoS One. 2016;11:e0157006.

    Article  Google Scholar 

  7. Tapp RJ, Shaw JE, Harper CA, et al. The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care. 2003;26:1731–7.

    Article  Google Scholar 

  8. Zhang X, Saaddine JB, Chou C-F, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. Jama. 2010;304:649–56.

    CAS  Article  Google Scholar 

  9. Kostev K, Rathmann W. Diabetic retinopathy at diagnosis of type 2 diabetes in the UK: a database analysis. Diabetologia. 2013;56:109–11.

    CAS  Article  Google Scholar 

  10. Nicolau J, Romerosa JM, Rodríguez I, et al. Associations of food addiction with metabolic control, medical complications and depression among patients with type 2 diabetes. Acta Diabetol. 2020;57:1093–100.

    CAS  Article  Google Scholar 

  11. Takii M, Uchigata Y, Nozaki T, et al. Classification of type 1 diabetic females with bulimia nervosa into subgroups according to purging behavior. Diabetes Care. 2002;25:1571–5.

    Article  Google Scholar 

  12. Rodin G, Olmsted MP, Rydall AC, et al. Eating disorders in young women with type 1 diabetes mellitus. J Psychosom Res. 2002;53:943–9.

    Article  Google Scholar 

  13. American Psychiatric Association. DSM-V. 2013.

  14. Nielsen S. Eating disorders in females with type 1 diabetes: an update of a meta-analysis. Eur Eating Disord Rev. 2002;10:241–54.

    Article  Google Scholar 

  15. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Joanna Briggs Institute Checklist for Cohort Studies. https://jbi.global/sites/default/files/2021-03/Checklist_for_Cohort_Studies.docx. Accessed 24 Jun 2021.

  17. Joanna Briggs Institute Checklist for Case Control Studies. https://jbi.global/sites/default/files/2021-03/Checklist_for_Case_Control_Studies.docx. Accessed 24 Jun 2021.

  18. Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. https://jbi.global/sites/default/files/2021-03/Checklist_for_Analytical_Cross_Sectional_Studies.docx. Accessed 24 Jun 2021.

  19. Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive Meta analysis. Englewood, NJ: Biostat; 2013.

    Google Scholar 

  20. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  Google Scholar 

  21. Egger M, Smith GD, Schneider M, Minder C. Bias in meta ­ analysis detected by a simple, graphical test. BMJ. Br Med J. 1997; https://doi.org/10.1136/bmj.315.7109.629.

  22. Sterne JA, Egger M, Moher D (2008) Addressing reporting biases. Cochrane handbook for systematic reviews of interventions: Cochrane book series 297–333.

  23. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj. 2008;336:924–6.

    Article  Google Scholar 

  24. 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;336:1849–54.

    CAS  Article  Google Scholar 

  25. Cantwell R, Steel JM. Screening for eating disorders in diabetes mellitus. J Psychosom Res. 1996;40:15–20.

    CAS  Article  Google Scholar 

  26. Nicolau J, Simó R, Sanchís P, et al. Eating disorders are frequent among type 2 diabetic patients and are associated with worse metabolic and psychological outcomes: results from a cross-sectional study in primary and secondary care settings. Acta Diabetol. 2015;52:1037–44.

    CAS  Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  28. Colas C. Eating disorders and retinal lesions in type 1 (insulin-dependent) diabetic women. Diabetologia. 1991;34:288–8.

    CAS  Article  Google Scholar 

  29. Takii M, Komaki G, Uchigata Y, et al. Differences between bulimia nervosa and binge-eating disorder in females with type 1 diabetes: the important role of insulin omission. J Psychosom Res. 1999;47:221–31.

    CAS  Article  Google Scholar 

  30. Goldstein DE, Blinder KJ, Ide CH, et al. Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus: results of a 12-year longitudinal study. Ophthalmology. 1993;100:1125–32. https://doi.org/10.1016/S0161-6420(93)31516-2.

    CAS  Article  PubMed  Google Scholar 

  31. Henricsson M, Nilsson A, Janzon L, Groop L. The effect of glycaemic control and the introduction of insulin therapy on retinopathy in non-insulin-dependent diabetes mellitus. Diabet Med. 1997;14:123–31.

    CAS  Article  Google Scholar 

  32. Çelik S, Kayar Y, Önem Akçakaya R, et al. Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients. Gen Hosp Psychiatry. 2015;37:116–9. https://doi.org/10.1016/j.genhosppsych.2014.11.012.

    Article  PubMed  Google Scholar 

  33. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994;16:363–70.

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mike Trott.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Ethics approval

As this was a review on already published papers, no ethical approval was required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 107 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Trott, M., Driscoll, R., Iraldo, E. et al. Pathological eating behaviours and risk of retinopathy in diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord 21, 1047–1054 (2022). https://doi.org/10.1007/s40200-022-00980-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40200-022-00980-x

Keywords

  • Diabetes
  • Diabetic retinopathy
  • Eating disorder
  • Disordered eating