Eating disturbances have been estimated to be present in up to one-third of young women with diabetes mellitus. Eating disorders are more common in female adolescents with diabetes than in their peers without diabetes and in women with type 1 diabetes. All-cause mortality is 4–14 times higher in women with anorexia nervosa compared with the general population, and it is even higher in those who have both diabetes and eating disorders. Patients with diabetes and disordered eating have also been shown to have an increased risk of retinopathy.
For diabetes, the dietary regimen emphasizes intense meal timing and consistency. In addition, the hunger associated with hypoglycemia encourages binge eating. Given the emphasis that young women often place on body weight, maintaining optimal diabetes control is a particular challenge. The diagnosis is typically made in a patient with diabetes who has worsening diabetic control, when other causes of worsening control have been ruled out.
Patients with diabetes may report polydipsia, polyuria, or weight loss. In addition, upon questioning, they may report disturbed eating patterns. Other symptoms associated with eating disorders, such as disturbance of body image and menstrual irregularities, may be present.
The main laboratory finding will be a trend of increasing levels of hemoglobin A1C.
The main differential diagnoses are other causes of worsening glycemic control, including infection, or metabolic disease, such as hyperthyroidism.
There is currently no evidence to support any particular strategies for the treatment of disordered eating in women with diabetes. Proposed strategies for at-risk women include nutritional counseling to promote healthy eating instead of dietary restraint, regular (instead of fixed) meal and snack times, less intensive insulin therapy to reduce weight gain, and family counseling to improve communication.
No studies have evaluated the optimal treatment of patients with diabetes and established eating disorders. Presumably, strategies that are effective for patients without diabetes, such as cognitive-behavioral therapy and medications, will be effective. In addition, management strategies for diabetes that do not require patients to constantly think about food may be beneficial.
et al. 25 years of psychological research investigating disordered eating in people with diabetes: what have we learnt? Diabet Med. 2020;37:401.