Treatments in Endocrinology

, Volume 1, Issue 3, pp 155–162

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

  • Ann E. Goebel-Fabbri
  • Janna Fikkan
  • Alexa Connell
  • Laura Vangsness
  • Barbara J. Anderson
Therapy In Practice


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.


  1. 1.
    Kahn CR, Weir GC. Joslin’s diabetes mellitus. 13th ed. Malvern: Lea & Febiger, 1994Google Scholar
  2. 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): 977–86CrossRefGoogle Scholar
  3. 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): 567–73CrossRefGoogle Scholar
  4. 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): 1711–21CrossRefGoogle Scholar
  5. 5.
    Thompson CJ, Cummings JF, Chalmers J, et al. How have patients reacted to the implications of the DCCT? Diabetes Care 1996; 19(8): 876–9PubMedCrossRefGoogle Scholar
  6. 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): 76–80PubMedCrossRefGoogle Scholar
  7. 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: 199–206Google Scholar
  8. 8.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  9. 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: 207–11Google Scholar
  10. 10.
    Walsh BT, Garner DM. Diagnostic issues. In: Garner DM, Garfinkle PE, editors. Handbook of treatment for eating disorders. New York: Guilford, 1997: 25–33Google Scholar
  11. 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): 1563–6PubMedCrossRefGoogle Scholar
  12. 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: 79–86PubMedCrossRefGoogle Scholar
  13. 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): 179–82Google Scholar
  14. 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): 17–20PubMedCrossRefGoogle Scholar
  15. 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): 1956–60PubMedCrossRefGoogle Scholar
  16. 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): 21–5PubMedCrossRefGoogle Scholar
  17. 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): 1849–54PubMedCrossRefGoogle Scholar
  18. 18.
    Biggs MM, Basco MR, Patterson G, et al. Insulin withholding for weight control in women with diabetes. Diabetes Care 1994; 17(10): 1186–9PubMedCrossRefGoogle Scholar
  19. 19.
    Polansky WH, Anderson BJ, Lohrer PA, et al. Insulin omission in women with IDDM. Diabetes Care 1994; 17: 1178–85CrossRefGoogle Scholar
  20. 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): 162–7PubMedCrossRefGoogle Scholar
  21. 21.
    Rodin GM, Daneman D. Eating disorders and IDDM: a problematic association. Diabetes Care 1992; 15(10): 1402–12PubMedCrossRefGoogle Scholar
  22. 22.
    American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 2001; 24Suppl. 1: S44–7Google Scholar
  23. 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: 144–72Google Scholar
  24. 24.
    Polivy J, Herman CP. Dieting and binging. A causal analysis. Am Psychol 1985; 40(2): 193–201PubMedCrossRefGoogle Scholar
  25. 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): 934–42PubMedCrossRefGoogle Scholar
  26. 26.
    Cox DJ, Irvine A, Gonder-Frederick L, et al. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care 1987; 10(5): 617–21PubMedCrossRefGoogle Scholar
  27. 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, 2002Google Scholar
  28. 28.
    Garner DM, Olmsted MP. The eating disorders inventory (EDI) manual. Odessa (FL): Psychological Assessment Resources, 1984Google Scholar
  29. 29.
    Garner DM, Olmsted MP, Bohr Y, et al. The eating attitudes test: psychometric features and clinical correlates. Psychol Med 1982; 12: 871–8PubMedCrossRefGoogle Scholar
  30. 30.
    Cooper Z, Cooper PJ, Fairburn CG. The validity of the eating disorder examination and its subscales. Br J Psychiatry 1989; 154: 807–12PubMedCrossRefGoogle Scholar
  31. 31.
    LaGreca AM, Schwartz LT, Satin W. Eating patterns in young women with IDDM: another look [letter]. Diabetes Care 1987; 10: 659–60Google Scholar
  32. 32.
    Levine MD, Marcus MD. Women, diabetes and disordered eating. Diabetes Spectrum 1997; 10: 191–5Google Scholar
  33. 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): 81–6PubMedCrossRefGoogle Scholar
  34. 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: 383–93Google Scholar

Copyright information

© Adis Data Information BV 2002

Authors and Affiliations

  • Ann E. Goebel-Fabbri
    • 1
  • Janna Fikkan
    • 1
  • Alexa Connell
    • 1
  • Laura Vangsness
    • 1
  • Barbara J. Anderson
    • 1
  1. 1.Harvard Medical SchoolJoslin Diabetes CenterBostonUSA
  2. 2.Behavioral and Mental Health UnitJoslin Diabetes CenterBostonUSA

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