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Niemelä PE, Leppänen HA, Voutilainen A, Möykkynen EM, Virtanen KA, Ruusunen AA, Rintamäki RM. Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis. Eat Behav 2024; 53:101863. [PMID: 38452627 DOI: 10.1016/j.eatbeh.2024.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
AIMS To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms. METHODS We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission. RESULTS A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21-0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24-0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ2 = 85.83, df = 8, p < .0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26-0.34) vs. 18 % (95 % Cl 0.14-0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13-0.33). CONCLUSIONS Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates.
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Affiliation(s)
- Pia E Niemelä
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Hanna A Leppänen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Ari Voutilainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Essi M Möykkynen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Kirsi A Virtanen
- Faculty of Medicine, Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Anu A Ruusunen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland; IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Reeta M Rintamäki
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
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Dziewa M, Bańka B, Herbet M, Piątkowska-Chmiel I. Eating Disorders and Diabetes: Facing the Dual Challenge. Nutrients 2023; 15:3955. [PMID: 37764739 PMCID: PMC10538145 DOI: 10.3390/nu15183955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Eating disorders and diabetes mellitus are distinct yet closely linked health conditions, presenting distinct challenges in terms of care and management. Eating disorders encompass a spectrum of mental health disorders characterized by abnormal eating behaviors and disruptions in weight regulation. Research indicates that individuals with diabetes might be at an elevated risk of developing eating disorders. The necessity to adhere to specific dietary guidelines, monitor blood sugar levels vigilantly, and manage drug administration can collectively contribute to the emergence of detrimental attitudes toward food and body image. On the other hand, incorrect eating behaviors such as binge eating and purging can disrupt blood sugar control, significantly impacting the development and management of diabetes. This intricate relationship emphasizes the crucial necessity for a comprehensive understanding and specialized care to effectively address the dual challenges faced by individuals dealing with both diabetes and eating disorders. This paper represents the inaugural comprehensive review delving into the intricate connection between eating disorders and diabetes, thereby illuminating previously under-researched areas. The insights gleaned from this review may contribute to developing integrated interventions that aim to improve the overall well-being and quality of life for individuals grappling with the complexities of eating disorders and diabetes.
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Affiliation(s)
| | | | | | - Iwona Piątkowska-Chmiel
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8b Street, 20-090 Lublin, Poland
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Goddard G, Oxlad M, Turnbull D. The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review. J Diabetes Metab Disord 2023; 22:13-34. [PMID: 37255778 PMCID: PMC10225459 DOI: 10.1007/s40200-022-01151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
Background Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males' misuse of insulin for weight and/or shape control. Methods A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021. Results A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies). Conclusion Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01151-8.
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Affiliation(s)
- Georgia Goddard
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
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4
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Hildebrandt BA, Fisher H, LaPalombara Z, Young ME, Ahmari SE. Corticostriatal dynamics underlying components of binge-like consumption of palatable food in mice. Appetite 2023; 183:106462. [PMID: 36682623 PMCID: PMC9974784 DOI: 10.1016/j.appet.2023.106462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
Binge eating (BE) is a maladaptive repetitive feeding behavior present across nearly all eating disorder diagnoses. Despite the substantial negative impact of BE on psychological and physiological health, its underlying neural mechanisms are largely unknown. Other repetitive behavior disorders (e.g., obsessive compulsive disorder) show dysfunction within corticostriatal circuitry. However, to date, no work has investigated the in vivo neural dynamics underlying corticostriatal activity during BE episodes. The aim of the current study was to longitudinally examine in vivo neural activity within corticostriatal regions - the infralimbic cortex (IL) and dorsolateral striatum (DLS)- in a robust pre-clinical model for BE. Female C57BL6/J mice (N = 32) were randomized to receive: 1) intermittent (daily, 2-h) binge-like access to palatable food (sweetened condensed milk) (BE), or 2) continuous, non-intermittent (24-h) access to palatable food (control). In vivo calcium imaging was performed via fiber photometry at baseline and after chronic (4 weeks) engagement in the model for BE. Specific consummatory behaviors (feeding bout onset/offset) during recordings were captured using lickometers which generated TTL outputs for precise alignment of behavior to neural data. IL showed no specific changes in neural activity related to BE. However, BE animals showed decreased DLS activity at feeding onset and offset at the chronic timepoint when compared to activity at the baseline timepoint. Additionally, BE mice had significantly lower DLS activity at feeding onset and offset at the chronic timepoint compared to control mice. These results point to a role for DLS hypofunction in chronic BE, highlighting a potential target for future treatment intervention.
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Affiliation(s)
- Britny A Hildebrandt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
| | - Hayley Fisher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Zoe LaPalombara
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Michael E Young
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Susanne E Ahmari
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, PA, 15213, USA
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5
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Salvia MG, Ritholz MD, Craigen KLE, Quatromoni PA. Managing type 2 diabetes or prediabetes and binge eating disorder: a qualitative study of patients' perceptions and lived experiences. J Eat Disord 2022; 10:148. [PMID: 36221145 PMCID: PMC9554983 DOI: 10.1186/s40337-022-00666-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The overlap in prevalence between type 2 diabetes and binge eating disorder is substantial, with adverse physical and mental health consequences. Little is known about patients' efforts at managing these two conditions simultaneously. The research objective was to explore patients' experiences managing co-existing type 2 diabetes or prediabetes and binge eating disorder. METHODS This is a qualitative descriptive study using semi-structured interviews. Participants included 21 women with type 2 diabetes or prediabetes (90% non-Hispanic White; mean age 49 ± 14.8 years, mean BMI 43.8 ± 8.4; 48% with type 2 diabetes and mean HbA1c was 8.4%). Interviews were analyzed using thematic analysis and NVivo software. RESULTS Qualitative analysis revealed that participants reported binge episodes frequently started in childhood or adolescence and went undiagnosed for decades; notably, they recalled that diabetes diagnosis preceded the binge eating disorder diagnosis. They also described trying to lose weight throughout their lives and how feelings of deprivation, shame, and failure exacerbated binge eating. Participants further reported how binge eating made diabetes self-care and outcomes worse. Finally, participants observed that when binge eating disorder treatment and diabetes management were synergistically integrated, they experienced improvements in both binge eating and glycemic outcomes. This integration included reframing negative thoughts surrounding binge eating disorder and diabetes self-management and increasing their understanding of how the two disorders were inter-related. CONCLUSION Findings highlight the importance of increasing healthcare providers' awareness of and screening for binge eating disorder in the treatment of diabetes and inform specific integrated interventions that address both diagnoses. From this study where we interviewed 21 women with binge eating disorder (BED) and type 2 diabetes/prediabetes, we learned how binge eating impacted diabetes management and how diabetes impacted BED. Most participants reported receiving the diabetes diagnosis before being diagnosed with BED despite the earlier onset of binge eating, pointing to the need for BED screening. Participants described trying to lose weight throughout their lives and reported feelings of failure and shame, which made binge eating worse. Binge eating made diabetes management harder, but when diabetes and BED treatment were aligned, participants experienced improvements in binge symptoms and diabetes outcomes.
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Affiliation(s)
- Meg G Salvia
- Department of Health Sciences, Boston University, 635 Commonwealth Avenue, 02215, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA
| | - Marilyn D Ritholz
- Joslin Diabetes Center, 1 Joslin Place, 02215, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, 02215, Boston, MA, USA
| | | | - Paula A Quatromoni
- Department of Health Sciences, Boston University, 635 Commonwealth Avenue, 02215, Boston, MA, USA. .,Walden Behavioral Care, 51 Sawyer Road, 02453, Waltham, MA, USA.
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Shakeri Z, Mardali F, Azizabadi Farahani M, Alemrajabi M, Mottaghi A. Comparison of eating disorders and eating behaviors in adults with and without type 2 diabetes prior to bariatric surgery. J Eat Disord 2022; 10:107. [PMID: 35854337 PMCID: PMC9295507 DOI: 10.1186/s40337-022-00623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are group of psychological disorders that significantly impair physical health and psychosocial function. ED consists wide range of morbidity such as loss of eating control, binge eating disorder (BED), night eating syndrome, and bulimia nervosa. Eating behavior is a wide range term that includes food choices, eating patterns, eating problems. In this study, we compared eating disorders and eating behaviors in adults with and without type 2 diabetes prior to bariatric surgery. METHODS 284 participants with class III obesity were included in the single center study. Each case (patients with type 2 diabetes) and control (patients without type 2 diabetes) groups consists 142 patients. Loss of eating control, BED and Bulimia nervosa, Night eating syndrome and eating behaviors and psychosocial factors were screened with standard questionnaires. SPSS version 20 was used for statistical analysis. A P-value of < 0.05 was considered significant. RESULTS There was a significant difference between participants with and without type 2 diabetes in case of BED (76.3% vs. 47.3%, P = 0.001). The logistic regression model has shown that participants without type 2 diabetes had lower odds of exhibiting BED (OR = 0.28, 95% CI 0.142-0.552). Among participants without type 2 diabetes, men had 65% high odds of BED (OR = 1.65, 95% CI 1.13-2.53) in compare with women. Participants with and without type 2 diabetes with high school degree (OR = 5.54, 95% CI 2.46-9.45, P = 0.0001 and OR = 6.52, 95% CI 3.15-10.56, respectively) and moderate depression level (OR = 2.03, 95% CI 0.98-3.95 and OR = 3.12, 95% CI 2.12-4.56, P = 0.0001) had higher odds of BED. CONCLUSION These results probably indicate that people with Class III obesity are more cautious about their diet for blood glucose control if they have type 2 diabetes. Future studies are recommended to follow up these patients after surgery to compare weight loss and blood sugar control in patients with and without type 2 diabetes.
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Affiliation(s)
- Zeinab Shakeri
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Farzaneh Mardali
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Azadeh Mottaghi
- Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology and Metabolism, University of Medical Sciences, Tehran, Iran.
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7
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Kumar P, Patel R, Muhammad T, Srivastava S. Does engagement in frequent physical activity improve diabetes mellitus among older adults in India? A propensity score matching approach. Diabetes Metab Syndr 2022; 16:102353. [PMID: 34920198 DOI: 10.1016/j.dsx.2021.102353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Diabetes is a major chronic condition and was identified as one of the four priority non-communicable diseases that the United Nations targeted because of its increasing disease burden. The present study aims to examine the impact of physical activity on improving diabetes mellitus among older adults in India. METHODS This study utilizes data from India's first nationally representative longitudinal ageing survey (2017-18). Descriptive along with bivariate analysis was used to present the preliminary results. Additionally, Propensity score matching (PSM) analysis was used. RESULTS About 14% of older adults suffered from diabetes. Eighteen percent of older adults did frequent physical activity. The estimated average treatment effect on the treated (ATT) values in treated and control groups were 0.123 and 0.147, respectively, indicating that the prevalence of diabetes among older adults was reduced by 2.5% points because of frequent physical activity. The average treatment effect on the untreated (ATU) results indicates that among older adults who did not do frequent physical activity, if they did frequent physical activity, the prevalence of diabetes is likely to decrease by 2.2% points. CONCLUSION Our findings show that frequent physical activity is associated with a lower risk of diabetes in older adults. The results underscore the need to develop strategies of promoting an active lifestyle by maintaining physical activity to combat the diabetes epidemic in the older population.
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Affiliation(s)
- Pradeep Kumar
- Population Council, India Country Office, 5A, GF, India Habitat Centre, New Delhi, Delhi, 110003, India.
| | - Ratna Patel
- International Institute for Population Sciences, Mumbai, Maharashtra, 110048, India.
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 110048, India.
| | - Shobhit Srivastava
- Department of Research and Innovation, Mamta Health Institute for Mother and Child, New Delhi, 110048, India.
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8
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Oldham-Cooper R, Semple C. Prevention and early help for eating disorders in young people with type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:656-668. [PMID: 33601920 DOI: 10.1177/1359104521994172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is building evidence that early intervention is key to improving outcomes in eating disorders, whereas a 'watch and wait' approach that has been commonplace among GPs and other healthcare professionals is now strongly discouraged. Eating disorders occur at approximately twice the rate in individuals with type 1 diabetes compared to the general population. In this group, standard eating disorder treatments have poorer outcomes, and eating disorders result in a particularly high burden of morbidity. Therefore, our first priority must be prevention, with early intervention where disordered eating has already developed. Clinicians working in both eating disorders and diabetes specialist services have highlighted the need for multidisciplinary team collaboration and specific training, as well as improved treatments. We review the current evidence and future directions for prevention, identification and early intervention for eating disorders in children and young people with type 1 diabetes.
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
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Oldham-Cooper R, Semple C, Wilkinson LL. Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes. Clin Child Psychol Psychiatry 2021; 26:669-681. [PMID: 33601940 DOI: 10.1177/1359104520986215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach).
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
| | - Laura L Wilkinson
- Department of Psychology, College of Human & Health Sciences, Swansea University, Singleton Park, UK
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10
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Hildebrandt BA, Ahmari SE. Breaking It Down: Investigation of Binge Eating Components in Animal Models to Enhance Translation. Front Psychiatry 2021; 12:728535. [PMID: 34484010 PMCID: PMC8414642 DOI: 10.3389/fpsyt.2021.728535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Binge eating (BE) is a core eating disorder behavior that is present across nearly all eating disorder diagnoses (e. g., bulimia nervosa, binge eating disorder, anorexia nervosa binge/purge subtype), and is also widely present in the general population. Despite the prevalence of BE, limited treatment options exist and there are often high rates of relapse after treatment. There is evidence showing that genetic factors contribute to the heritability of BE and support for biological contributions to BE. However, more work is needed to fully understand neurobiological mechanisms underlying BE. One approach to target this problem is to separate BE into its distinct clinical components that can be more easily modeled using pre-clinical approaches. To date, a variety of animal models for BE have been used in pre-clinical studies; but there have been challenges translating this work to human BE. Here, we review these pre-clinical approaches by breaking them down into three clinically-significant component parts (1) consumption of a large amount of food; (2) food consumption within a short period of time; and (3) loss of control over eating. We propose that this rubric identifies the most frequently used and effective ways to model components of BE behavior using pre-clinical approaches with the strongest clinical relevance. Finally, we discuss how current pre-clinical models have been integrated with techniques using targeted neurobiological approaches and propose ways to improve translation of pre-clinical work to human investigations of BE that could enhance our understanding of BE behavior.
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Affiliation(s)
- Britny A Hildebrandt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Susanne E Ahmari
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States
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11
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Chevinsky JD, Wadden TA, Chao AM. Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges. Diabetes Metab Syndr Obes 2020; 13:1117-1131. [PMID: 32341661 PMCID: PMC7166070 DOI: 10.2147/dmso.s213379] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.
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Affiliation(s)
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Ariana M Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
- Correspondence: Ariana M Chao University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA19104, USATel +1215-746-7183Fax +1215-898-2878 Email
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Worse Metabolic Control and Dynamics of Weight Status in Adolescent Girls Point to Eating Disorders in the First Years after Manifestation of Type 1 Diabetes Mellitus: Findings from the Diabetes Patienten Verlaufsdokumentation Registry. J Pediatr 2019; 207:205-212.e5. [PMID: 30579582 DOI: 10.1016/j.jpeds.2018.11.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess indications of eating disorders in girls with type 1 diabetes mellitus (T1DM). STUDY DESIGN In total 31 556 girls aged >6 months and <23 years of age with T1DM from the Diabetes Patienten Verlaufsdokumentation (DPV) cohort were analyzed including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) girls with bulimia nervosa, 45 (0.14%) girls with binge eating disorder, and 229 (0.73%) girls with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes of glycosylated hemoglobin A1c (HbA1c) levels, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders. Multiple logistic regression analyses were performed. RESULTS Eating disorders were significantly associated with late pubertal age, nonusage of pumps, no migration background, increased HbA1c levels, increased frequencies of DKA and severe hypoglycemia, and celiac disease were not related to eating disorders. Significant differences in HbA1c levels, prevalence of DKA and severe hypoglycemia between girls with and without eating disorders were already detectable in the first years after onset of T1DM. A decrease of body mass index (BMI)-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6-14.3] compared with stable BMI-SDS, 6.9-fold [95%CI 3.4-14.1] compared with increase of BMI-SDS). CONCLUSIONS Poor metabolic control and increased rates of DKA and severe hypoglycemia in the first years after manifestation of T1DM can be hints for eating disorders in girls with T1DM, and weight loss is specific for anorexia nervosa. These clinical features should lead to screening for eating disorders especially at a late pubertal age.
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Papelbaum M, de Oliveira Moreira R, Coutinho WF, Kupfer R, Freitas S, Raggio Luz R, Appolinario JC. Does binge-eating matter for glycemic control in type 2 diabetes patients? J Eat Disord 2019; 7:30. [PMID: 31516703 PMCID: PMC6728934 DOI: 10.1186/s40337-019-0260-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) treatment and may have an impact on glycemic control. Previous reports showed elevated prevalence of eating disordered behaviors, especially binge eating disorder in clinical samples of type 2 diabetes patients. However, results regarding the impact of an eating disorder on the glycemic and clinical control of T2DM is inconsistent. The purpose of this study was to assess the impact of a comorbid eating disorder on glycemic control (GC) in a group of patients with T2DM. METHODS Eating behaviors of 70 consecutive patients with T2DM were assessed using a Structured Clinical Interview for DSM-IV and the Binge Eating Scale. The GC was examined with fasting blood glucose (FBG) and glycated hemoglobin (A1c) levels. In addition, secondary clinical variables were assessed, including body mass index (BMI) and lipids. Chi-square and Student's T tests were used to compare clinical and psychopathological characteristics of patients with and without an ED. In order to evaluate the relationship between GC and eating disorder (ED) a linear regression analysis was performed, controlling for BMI. A significance level of 5% was adopted. RESULTS Seventy-seven percent of the sample (n = 54) were female and 50% were obese. Fourteen patients exhibited an ED, mostly binge eating disorder (BED). In a regression analysis, both FBG (beta coefficient = 47.4 (22.3); p = 0.037) and A1c (beta coefficient = 1.12 (0.57); p = 0.05) were predicted by the presence of an ED. However, the presence of an ED lost its impact on glycemic control outcomes after the addition of the BMI in the models. CONCLUSIONS Eating psychopathology is frequently observed in patients with T2DM. Among individuals with T2DM, co-morbid ED is associated with a poorer glycemic control in the presence of a higher BMI. The presence of an eating disordered behavior in patients with T2DM seems to have clinical relevance in the usual care of patients with diabetes. Therefore, we recommend eating psychopathology should be routinely assessed in T2DM patients.
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Affiliation(s)
- Marcelo Papelbaum
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil.,2Group of Obesity and Eating Disorders, Institute of Psychiatry of the Federal University of Rio de Janeiro and State Institute Diabetes and Endocrinology, Avenida Ataulfo de Paiva 204, 707, Leblon, Rio de Janeiro, 22440-033 Brazil
| | | | | | - Rosane Kupfer
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil
| | - Silvia Freitas
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil
| | - Ronir Raggio Luz
- 3Institute for Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Carlos Appolinario
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil.,2Group of Obesity and Eating Disorders, Institute of Psychiatry of the Federal University of Rio de Janeiro and State Institute Diabetes and Endocrinology, Avenida Ataulfo de Paiva 204, 707, Leblon, Rio de Janeiro, 22440-033 Brazil
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14
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Barber JA, Ivezaj V, Barnes RD. Comparing physical activity in individuals with overweight/obesity with and without binge eating disorder. Obes Sci Pract 2018; 4:134-140. [PMID: 29670751 PMCID: PMC5893463 DOI: 10.1002/osp4.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023] Open
Abstract
Objective Differential participation in physical activity (PA) may partially explain the health discrepancies between individuals with or without binge-eating disorder (BED). Yet, little is known about the PA habits of individuals with overweight/obesity and how those patterns may differ based on BED status. PA patterns and exercise self-efficacy were examined in individuals with overweight/obesity, with and without BED. Design Ninety-seven participants with overweight/obesity self-reported their PA via the Godin Leisure-Time Questionnaire and the Paffenbarger PA Questionnaire. Exercise self-efficacy was assessed with the Marcus 5-item Exercise Self-Efficacy scale. Based on the Eating Disorder Examination, 27.8% (n = 27) of the participants met BED criteria. Participants were primarily female (n = 75, 77.3%), on average 47.5 years old (standard deviation = 10.4), and predominantly White/Not Hispanic (n = 67, 69.1%) or African-American/Not Hispanic (n = 18, 18.6%). Results Hierarchical regressions, accounting for significant differences in body mass index between those with and without BED, showed that the Marcus 5-item Exercise Self-Efficacy Scale (but not BED status) was significantly related to PA. BED status also was unrelated to likelihood of reaching Centres for Disease Control PA guidelines, and 44.3% of all participants reported no participation in weekly sports/recreation activities. Conclusions Both groups participated in relatively little purposeful and moderate/strenuous PA. Exercise self-efficacy may be important to assess and address among treatment seeking individuals with and without BED who struggle with excess weight.
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Affiliation(s)
- J. A. Barber
- Psychology 116BVA Connecticut Healthcare SystemWest HavenCTUSA
- Department of PsychiatryYale University School of MedicineNew HavenCTUSA
| | - V. Ivezaj
- Department of PsychiatryYale University School of MedicineNew HavenCTUSA
| | - R. D. Barnes
- Department of PsychiatryYale University School of MedicineNew HavenCTUSA
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15
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Brar PC, Contreras M, Fan X, Visavachaipan N. Effect of one time high dose “stoss therapy” of vitamin D on glucose homeostasis in high risk obese adolescents. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:193-200. [PMID: 29641737 PMCID: PMC10118987 DOI: 10.20945/2359-3997000000024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the effect of using a one time high dose "stoss therapy" of vitamin D2 (ergocalciferol: VD2) on indices of insulin sensitivity {whole body sensitivity index: WBISI} and secretion {insulinogenic index: IGI} measured during an oral glucose tolerance test (OGTT) in obese adolescents with VDD (25 OHD; serum metabolite of vit D: < 30 ng/dL). SUBJECTS AND METHODS In a randomized placebo controlled cross over design 20 obese adolescents with vitamin D deficiency (VDD) had baseline OGTT. Arm A received one time high dose 300,000 IU of ergocalciferol and Arm B received placebo. After 6 weeks the adolescents were reassigned to Arm A if they were in Arm B and vice versa. 25OHD, calcium, parathyroid hormone, comprehensive metabolic panel, urine calcium creatinine ratio were measured at each study visit. OGTTs to assess indices of sensitivity and secretion were done at baseline, 6 weeks and 12 weeks respectively. RESULTS Adolescents were obese and insulin resistant (mean ± SD: mean age = 15.1 ± 1.9 years; BMI: 32.7 ± 9.8; homeostatic model of insulin resistance: HOMA-IR: 4.2 ± 2.8). Stoss therapy with VD2 increased 25OHD from baseline (16.7 ± 2.9 to 19.5 ± 4.5; p = 0.0029) when compared to the placebo. WBISI (2.8 ± 1.9) showed a trend towards improvement in Rx group (p = 0.0577) after adjustment for covariates. IGI (3 ± 2.2) showed an improvement in both Rx and placebo groups. CONCLUSIONS Our study demonstrated that using a high dose of VD2 (300,000 IU) did not have any beneficial effect on insulin sensitivity (whole body sensitivity index {WBISI}) and secretory indices (insulinogenic index {IGI}) in obese adolescents. High dose "stoss therapy" of VD2 did not appear to have any beneficial effect on glucose homeostasis on obese adolescents.
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16
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García-Mayor RV, García-Soidán FJ. Eating disoders in type 2 diabetic people: Brief review. Diabetes Metab Syndr 2017; 11:221-224. [PMID: 27575047 DOI: 10.1016/j.dsx.2016.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relationship between type 1 diabetes and Eating disorders is well-known, less information exists on the relationship between type 2 diabetes (T2DM) people and eating disorders. AIM Review information on the prevalence and impact of type 2 diabetes and eating disorders comorbidity. METHODS Search in Medline and PubMed relevant articles on the aforementioned co-morbidity. Review includes articles on epidemiological, clinical and therapeutics aspects. CONCLUSIONS Disordered eating behaviours may affect around 40% of T2DM people, being the predominant clinical forms: Eating Disorders Non otherwise specified (EDNOS), Night Eating Syndrome (NES) and Binge Eating Disorder (BED), however, population-based estimates of T2DM and ED comorbidity are mandatory to determine the prevalence of ED in T2DM people. The association between both entities has a consequence which is an impairment of metabolic control, associated to increase risk of vascular complications and difficult body weight loss, basis of T2DM treatment.
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Affiliation(s)
- Ricardo V García-Mayor
- South Galician Biomedical Foundation, University Hospital of Vigo, P.O. Box 1691, Vigo 36201, Spain.
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17
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Abstract
PURPOSE To gain further understanding of the general medical comorbidity of binge eating disorder (BED) beyond its association with obesity. METHOD We reviewed studies of general medical comorbidity in people with BED or clinically significant binge eating behavior beyond obesity. We also reviewed studies of BED in specific medical conditions. RESULTS Three broad study categories of medical comorbidity in BED were found: cross-sectional studies of medical conditions in BED; prospective studies of medical conditions in BED; and studies of BED in specific medical conditions. Cross-sectional epidemiologic data suggest that BED is associated with medical conditions related to obesity, including diabetes, hypertension, dyslipidemias, sleep problems/disorders, and pain conditions, and that BED may be related to these conditions independent of obesity and co-occurring psychiatric disorders. Prospective data suggest that BED may be associated with type 2 diabetes and metabolic syndrome. BED or binge eating behavior is also associated with asthma and gastrointestinal symptoms and disorders, and among women, menstrual dysfunction, pregnancy complications, intracranial hypertension, and polycystic ovary syndrome. CONCLUSIONS BED is associated with substantial medical comorbidity beyond obesity. Further study of the general medical comorbidity of BED and its relationship to obesity and co-occurring psychiatric disorders is greatly needed.
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18
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Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, Bulik CM. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Ann Intern Med 2016; 165:409-20. [PMID: 27367316 PMCID: PMC5637727 DOI: 10.7326/m15-2455] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The best treatment options for binge-eating disorder are unclear. PURPOSE To summarize evidence about the benefits and harms of psychological and pharmacologic therapies for adults with binge-eating disorder. DATA SOURCES English-language publications in EMBASE, the Cochrane Library, Academic OneFile, CINAHL, and ClinicalTrials.gov through 18 November 2015, and in MEDLINE through 12 May 2016. STUDY SELECTION 9 waitlist-controlled psychological trials and 25 placebo-controlled trials that evaluated pharmacologic (n = 19) or combination (n = 6) treatment. All were randomized trials with low or medium risk of bias. DATA EXTRACTION 2 reviewers independently extracted trial data, assessed risk of bias, and graded strength of evidence. DATA SYNTHESIS Therapist-led cognitive behavioral therapy, lisdexamfetamine, and second-generation antidepressants (SGAs) decreased binge-eating frequency and increased binge-eating abstinence (relative risk, 4.95 [95% CI, 3.06 to 8.00], 2.61 [CI, 2.04 to 3.33], and 1.67 [CI, 1.24 to 2.26], respectively). Lisdexamfetamine (mean difference [MD], -6.50 [CI, -8.82 to -4.18]) and SGAs (MD, -3.84 [CI, -6.55 to -1.13]) reduced binge-eating-related obsessions and compulsions, and SGAs reduced symptoms of depression (MD, -1.97 [CI, -3.67 to -0.28]). Headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal occurred more frequently with lisdexamfetamine than placebo (relative risk range, 1.63 to 4.28). Other forms of cognitive behavioral therapy and topiramate also increased abstinence and reduced binge-eating frequency and related psychopathology. Topiramate reduced weight and increased sympathetic nervous system arousal, and lisdexamfetamine reduced weight and appetite. LIMITATIONS Most study participants were overweight or obese white women aged 20 to 40 years. Many treatments were examined only in single studies. Outcomes were measured inconsistently across trials and rarely assessed beyond end of treatment. CONCLUSION Cognitive behavioral therapy, lisdexamfetamine, SGAs, and topiramate reduced binge eating and related psychopathology, and lisdexamfetamine and topiramate reduced weight in adults with binge-eating disorder. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Kimberly A Brownley
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
| | - Nancy D Berkman
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
| | - Christine M Peat
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
| | - Kathleen N Lohr
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
| | - Katherine E Cullen
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
| | - Carla M Bann
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden
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19
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Abstract
BACKGROUND Hypoglycemia in children and adolescents with type 1 diabetes has diverse etiologies. CASE CHARACTERISTICS We report recurrent hypoglycemia in three children with type 1 diabetes because of insulin overdose. INTERVENTION Hospitalization and counselling by treating team and psychologist helped in resolving the recurrent hypoglycemia. OUTCOME Improvement in glycemic control was achieved. MESSAGE Adolescents with type 1 diabetes may take extra insulin to consume more carbohydrates, or to seek attention. Parents should share the responsibility of care of adolescents during transition phase for better glycemic control.
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20
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Raevuori A, Suokas J, Haukka J, Gissler M, Linna M, Grainger M, Suvisaari J. Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa. Int J Eat Disord 2015; 48:555-62. [PMID: 25060427 DOI: 10.1002/eat.22334] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/02/2014] [Accepted: 07/06/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aimed to examine the prevalence and incidence of type 2 diabetes (T2D) in a large patient cohort treated for binge eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa. METHOD Patients (N = 2,342) treated at the Eating Disorder Unit of Helsinki University Central Hospital over the period up to 16 years were compared with matched general population controls (N = 9,368) in three stages: before entering to the treatment for an eating disorder, after the entrance until the end of the study period, and combined any time before, during, and after the treatment. The study population was linked with the oral TSD medication data of 17 years from The Medical Reimbursement Register. Data were analyzed using conditional and Poisson regression models. RESULTS Before entering to the treatment for eating disorders, the risk of T2D was substantially increased in patients compared with controls (OR 6.6, 95% CI 4.0-10.7). At the end of the study period, the lifetime prevalence of T2D was 5.2% among patients, 1.7% among controls (OR 3.4, 95% CI 2.6-4.4), and in male patients, it was significantly higher compared with females. Of those treated for BED, every third had T2D by the end of the study period (OR 12.9, 95% CI 7.4-22.5), whereas the same was true for 4.4% of those with BN (OR 2.4, 95% CI 1.7-3.5). DISCUSSION Our findings provide strong support for the association between T2D and clinically significant binge eating. Disturbed glucose metabolism may contribute to the onset and maintenance of BED and BN.
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Affiliation(s)
- Anu Raevuori
- Department of Public Health, Hjelt Institute, University of Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.,Department of Child Psychiatry, Faculty of Medicine, University of Turku, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suokas
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Helsinki University Central Hospital, Finland
| | - Jari Haukka
- Department of Public Health, Hjelt Institute, University of Helsinki, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Information Department, National Institute for Health and Welfare, Helsinki, Finland.,Nordic School of Public Health, Gothenburg, Sweden
| | - Milla Linna
- Department of Public Health, Hjelt Institute, University of Helsinki, Finland
| | - Marjut Grainger
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Social Psychiatry, Tampere School of Public Health, Finland
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21
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Çelik S, Kayar Y, Önem Akçakaya R, Türkyılmaz Uyar E, Kalkan K, Yazısız V, Aydın Ç, Yücel B. 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. [PMID: 25670634 DOI: 10.1016/j.genhosppsych.2014.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control. METHOD One hundred fifty-two T2DM patients aged between 18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores. RESULTS Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (P<.05). A positive correlation was found between EAT scores and depression scores (r = +0.196, P<.05). No significant difference was found in HbA1c levels between patients with BED and those without (P<.05). CONCLUSIONS T2DM patients should be examined in terms of the presence of BED and disordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression.
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Affiliation(s)
- Selime Çelik
- Sisli Etfal Research and Training Hospital Psychiatry Unıt, Sisli-İstanbul, Turkey.
| | - Yusuf Kayar
- Sisli Etfal Research and Training Hospital Internal Medicine Unıt, Sisli-İstanbul, Turkey
| | | | - Ece Türkyılmaz Uyar
- Sisli Etfal Research and Training Hospital Psychiatry Unıt, Sisli-İstanbul, Turkey
| | - Kübra Kalkan
- Sisli Etfal Research and Training Hospital Internal Medicine Unıt, Sisli-İstanbul, Turkey
| | - Veli Yazısız
- Akdeniz University Department of Internal Medicine, Antalya, Turkey
| | - Çiğdem Aydın
- Sisli Etfal Research and Training Hospital Psychiatry Unıt, Sisli-İstanbul, Turkey
| | - Başak Yücel
- Istanbul University Medical School Psychiatry Unıt, Istanbul, Turkey
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22
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Zhao K, Ao Y, Harper RM, Go VLW, Yang H. Food-intake dysregulation in type 2 diabetic Goto-Kakizaki rats: hypothesized role of dysfunctional brainstem thyrotropin-releasing hormone and impaired vagal output. Neuroscience 2013; 247:43-54. [PMID: 23701881 DOI: 10.1016/j.neuroscience.2013.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/25/2013] [Accepted: 05/02/2013] [Indexed: 12/11/2022]
Abstract
Thyrotropin-releasing hormone (TRH), a neuropeptide contained in neural terminals innervating brainstem vagal motor neurons, enhances vagal outflow to modify multisystemic visceral functions and food intake. Type 2 diabetes (T2D) and obesity are accompanied by impaired vagal functioning. We examined the possibility that impaired brainstem TRH action may contribute to the vagal dysregulation of food intake in Goto-Kakizaki (GK) rats, a T2D model with hyperglycemia and impaired central vagal activation by TRH. Food intake induced by intracisternal injection of TRH analog was reduced significantly by 50% in GK rats, compared to Wistar rats. Similarly, natural food intake in the dark phase or food intake after an overnight fast was reduced by 56-81% in GK rats. Fasting (48h) and refeeding (2h)-associated changes in serum ghrelin, insulin, peptide YY, pancreatic polypeptide and leptin, and the concomitant changes in orexigenic or anorexigenic peptide expression in the brainstem and hypothalamus, all apparent in Wistar rats, were absent or markedly reduced in GK rats, with hormone release stimulated by vagal activation, such as ghrelin and pancreatic polypeptide, decreased substantially. Fasting-induced Fos expression accompanying endogenous brainstem TRH action decreased by 66% and 91%, respectively, in the nucleus tractus solitarius (NTS) and the dorsal motor nucleus of the vagus (DMV) in GK rats, compared to Wistar rats. Refeeding abolished fasting-induced Fos-expression in the NTS, while that in the DMV remained in Wistar but not GK rats. These findings indicate that dysfunctional brainstem TRH-elicited vagal impairment contributes to the disturbed food intake in T2D GK rats, and may provide a pathophysiological mechanism which prevents further weight gain in T2D and obesity.
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Affiliation(s)
- K Zhao
- Research & Development, Department of Veterans Affairs, Greater Los Angeles Health Care System, Los Angeles, CA 90073, USA
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23
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Schober E, Wagner G, Berger G, Gerber D, Mengl M, Sonnenstatter S, Barrientos I, Rami B, Karwautz A, Fritsch M. Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12:627-31. [PMID: 21435136 DOI: 10.1111/j.1399-5448.2011.00759.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients. RESEARCH DESIGN AND METHODS Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison. RESULTS On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. CONCLUSION Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.
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Affiliation(s)
- Edith Schober
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
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24
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Zabka C. The evolving price of perfection. J Ren Nutr 2011; 21:e21-4. [PMID: 21871377 DOI: 10.1053/j.jrn.2011.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 06/07/2011] [Indexed: 11/11/2022] Open
Affiliation(s)
- Crystal Zabka
- Eating Disorder Program, OMNI Behavioral Health, Omaha, NE 68124, USA.
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25
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Altunay I, Demirci GT, Ates B, Kucukunal A, Aydın C, Karamustafalıoglu O, Altuntas Y. Do eating disorders accompany metabolic syndrome in psoriasis patients? Results of a preliminary study. Clin Cosmet Investig Dermatol 2011; 4:139-43. [PMID: 21931499 PMCID: PMC3173015 DOI: 10.2147/ccid.s24165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Metabolic syndrome (MBS) has been reported as a frequent comorbidity in psoriatic patients. The main pathogenesis is considered to be inflammation in this association. MBS has been investigated in eating disorders as well. While psoriasis has some psychiatric comorbidities, the link between psoriasis, MBS, and eating disorders (EDs) is unknown. METHODS The study was designed as a cross-sectional, randomized, and controlled trial. A total of 100 patients with psoriasis were included in the study. Sociodemographic data, clinical subtype of psoriasis, Psoriasis Area and Severity Index (PASI) scores, and associated diseases were registered for each patient. The criteria for diagnosis of MBS developed by the International Diabetes Foundation (IDF) was used. These are central obesity (waist circumference ≥94 cm in men or ≥80 cm in women), plus two of the following: elevated triglycerides (≥150 mg/dL), reduced high-desity lipoprotein cholesterol (>40 mg/dL for men; >50 mg/dL for women), elevated blood pressure (≥130 mmHg systolic or ≥85 mmHg diastolic), and elevated fasting blood glucose (≥100 mg/dL). Additionally, the Eating Attitude Test (EAT), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), and psychiatric interview were performed for all patients. RESULTS There were 45 female and 55 male patients, aged between 18 and 85 years old (median 41.12 ± 16.01). MBS was present in 31% of the patients with psoriasis. There was no correlation between the severity of psoriasis and MBS. EAT scores were ≥30 in 7/100 patients. Four out of 31 patients with MBS (12.9%) had ED and 3/69 patients were without MBS (4.3%). Mean ED scores were compared statistically and the difference was significant (EAT = 17.9 ± 9.558 and 11.5 ± 7.204, P < 0.001). CONCLUSION Defining risk factors leading to comorbidities is important in psoriasis. EDs seem to have an impact on the development of MBS in psoriasis. Establishment and treatment of EDs in patients with psoriasis may prevent the onset of MBS and other comorbidities due to MBS.
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Affiliation(s)
- Ilknur Altunay
- Dermatology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Bilge Ates
- Dermatology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Aslı Kucukunal
- Dermatology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Aydın
- Psychology Department, Istanbul University, Istanbul, Turkey
| | | | - Yuksel Altuntas
- Internal Medicine Endocrinology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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Webb JB, Applegate KL, Grant JP. A comparative analysis of Type 2 diabetes and binge eating disorder in a bariatric sample. Eat Behav 2011; 12:175-81. [PMID: 21741014 DOI: 10.1016/j.eatbeh.2011.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 03/10/2011] [Accepted: 04/14/2011] [Indexed: 01/23/2023]
Abstract
An emerging literature has illuminated an important link between Type 2 diabetes mellitus (DM) and binge eating disorder (BED) within obese cohorts. However, prior work has not examined this relationship specifically in a weight loss surgery (WLS) sample or fully explored potential psychosocial factors associated with this co-occurrence. Therefore, the present investigation sought to identify socio-demographic (i.e. age, education, BMI, ethnicity, gender, age of obesity onset) and psychological (i.e. depressive symptoms, hedonic hunger/food locus of control beliefs, severity of binge eating-related cognitions) correlates of the co-occurrence of Type 2 DM and BED among bariatric surgery candidates. An archival sample of 488 patients seeking surgical treatment for clinical obesity completed a standard battery of pre-operative psychosocial measures. The presence of BED was evaluated using a semi-structured clinical interview based on the DSM-IV TR (APA, 2000) and was further corroborated by responses on the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R; Spitzer, Yanovski, & Marcus, 1993). Results indicated that 8.2% of the sample was classified as having both Type 2 DM and BED concurrently. A multivariate logistic regression model revealed that in addition to other psychological (e.g., binge eating-related cognitions, hedonic hunger) and demographic variables (i.e. male gender), African American ethnicity (OR=3.3: 1.41-7.73) was a particularly robust indicator of comorbid status. Findings support and extend previous health disparity research urging greater attention to the needs of traditionally underserved, at-risk populations seeking treatment for obesity complicated by dysregulated eating and metabolism. Additionally, these preliminary results underscore the relevance of considering the potential benefits of providing quality comprehensive pre- and post-operative psychological care among bariatric patients towards optimizing both short- and long-term health and well-being.
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Affiliation(s)
- Jennifer B Webb
- UNC Charlotte Department of Psychology, 9201 University City Blvd., Charlotte, NC 28223, USA.
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Le Floch JP. Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics. Diabetes Metab Syndr Obes 2010; 3:197-213. [PMID: 21437089 PMCID: PMC3047990 DOI: 10.2147/dmsott.s7315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option.
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Affiliation(s)
- Jean-Pierre Le Floch
- Correspondence: Jean-Pierre Le Floch, Department of Diabetology, Medical Clinic, 8 Boulevard Richerand, 94440 Villecresnes, France, Tel +33 145 955 757, Fax +33 145 697 584, Email
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Meneghini L, Liebl A, Abrahamson MJ. Insulin detemir: A historical perspective on a modern basal insulin analogue. Prim Care Diabetes 2010; 4 Suppl 1:S31-S42. [PMID: 20394890 DOI: 10.1016/s1751-9918(10)60007-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Insulin detemir provides prolonged, reproducible blood glucose reduction through a mechanism unique among basal insulins. It was originally studied clinically in predominantly basal + bolus regimens and found to be associated with a low risk of hypoglycaemia compared to insulin NPH, and reduced weight gain compared to other basal insulins. Insulin detemir has been increasingly studied in basal-only insulin regimens in type 2 diabetes, in which an understanding of how to optimize its use has been built incrementally. Glycaemic control and limitation of weight gain tend to be maximized by once-daily (evening) dosing, earlier initiation and careful titration to appropriate fasting glucose targets.
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Affiliation(s)
- Luigi Meneghini
- University of Miami Miller School of Medicine, Florida 33136, USA
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30
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Young-Hyman DL, Davis CL. Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification. Diabetes Care 2010; 33:683-9. [PMID: 20190297 PMCID: PMC2827531 DOI: 10.2337/dc08-1077] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Deborah L Young-Hyman
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia, USA.
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31
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Galarce EM, Holland PC. Effects of cues associated with meal interruption on feeding behavior. Appetite 2009; 52:693-702. [PMID: 19501768 DOI: 10.1016/j.appet.2009.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/11/2009] [Accepted: 03/19/2009] [Indexed: 11/16/2022]
Abstract
Food consumption is controlled by both internal and external factors. Environmental signals associated with food may prepare an animal to forage, consume and digest more effectively. Furthermore, environmental cues that provide information about food availability enable animals to make predictions about future food resources and act upon that knowledge in appropriate fashion. For example, when exposed to a cue that signals the presence of food, animals can eat beyond their present needs to cope with predicted future famine. Interestingly, cues previously paired with meal interruption have a similar effect. In two experiments, food-deprived rats learned to associate one conditioned stimulus (CS+) with delivery of a food unconditioned stimulus (US), and another stimulus (IS) with an unexpected termination of CS-US trials. Subsequently, both CS+ and IS enhanced consumption of the US food by sated rats. The results of Experiment 2 indicated that IS's ability to potentiate feeding of sated rats in test depended more on its accompanying CS+ termination in training than on its signaling reductions in US frequency. These experiments may provide a novel animal model of binge-like behaviors in sated rats induced by external cues paired with meal interruption.
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Affiliation(s)
- Ezequiel M Galarce
- Department of Psychological and Brain Sciences, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, United States.
| | - Peter C Holland
- Department of Psychological and Brain Sciences, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, United States
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Gorin AA, Niemeier HM, Hogan P, Coday M, Davis C, DiLillo VG, Gluck ME, Wadden TA, West DS, Williamson D, Yanovski SZ. Binge eating and weight loss outcomes in overweight and obese individuals with type 2 diabetes: results from the Look AHEAD trial. ACTA ACUST UNITED AC 2008; 65:1447-55. [PMID: 19047532 DOI: 10.1001/archpsyc.65.12.1447] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Binge eating (BE) is common in overweight and obese individuals with type 2 diabetes mellitus, but little is known about how BE affects weight loss in this population. OBJECTIVE To determine whether BE was related to 1-year weight losses in overweight and obese individuals with type 2 diabetes participating in an ongoing clinical trial. DESIGN, SETTING, AND PARTICIPANTS The Look AHEAD (Action for Health in Diabetes) trial is a randomized controlled trial examining the long-term effect of intentional weight loss on cardiovascular disease in overweight and obese adults with type 2 diabetes. A total of 5145 overweight and obese individuals aged 45 to 76 years with type 2 diabetes participated in this study. INTERVENTIONS Participants were randomly assigned to an intensive lifestyle intervention or to enhanced usual care (a diabetes support and education control condition). MAIN OUTCOME MEASURES At baseline and 1 year, participants had their weight measured and completed a fitness test and self-report measures of BE and dietary intake. Four groups were created based on BE status at baseline and 1 year (yes/yes, no/no, yes/no, and no/yes). Analyses controlled for baseline differences between binge eaters and non-binge eaters. RESULTS Most individuals (85.4%) did not report BE at baseline or 1 year (no/no), 7.5% reported BE only at baseline (yes/no), 3.7% reported BE at both times (yes/yes), and 3.4% reported BE only at 1 year (no/yes), with no differences between intensive lifestyle intervention and diabetes support and education conditions (P = .14). Across intensive lifestyle intervention and diabetes support and education, greater weight losses were observed in participants who stopped BE at 1 year (mean [SE] weight loss, 5.3 [0.4] kg) and those who reported no BE at either time (mean [SE] weight loss, 4.8 [0.1] kg) than in those who continued BE (mean [SE] weight loss, 3.1 [0.6] kg) and those who began BE at 1 year (mean [SE] weight loss, 3.0 [0.6] kg) (P < .001). Post hoc analyses suggested that these differences were due to changes in caloric intake. CONCLUSION Overweight and obese individuals with type 2 diabetes who stop BE appear to be just as successful at weight loss as non-binge eaters after 1 year of treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00017953.
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Affiliation(s)
- Amy A Gorin
- Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Rd, Unit 1248, Storrs, CT 06269-1248, USA.
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Ryan M, Gallanagh J, Livingstone MB, Gaillard C, Ritz P. The prevalence of abnormal eating behaviour in a representative sample of the French diabetic population. DIABETES & METABOLISM 2008; 34:581-6. [PMID: 18922726 DOI: 10.1016/j.diabet.2008.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/05/2008] [Accepted: 05/19/2008] [Indexed: 10/21/2022]
Abstract
AIM To assess the relationship between abnormal eating behaviour (AEB) and diabetes in a sample of French adult patients with type 1 (T1D) and type 2 (T2D) diabetes. METHODS Ninety-four consecutively recruited patients self-completed a series of validated questionnaires. RESULTS Over one-fourth of men with T1D (26%) or T2D (27%) and 11% of female T2D patients reported consistent and pathological overeating or binge-eating during the previous six months. Glycaemic control in these T1D patients was poorer than in T1D patients defined as normal eaters (NORM) (11.9% versus 9.6%), but did not reach statistical significance (P=0.08), and no significant difference was observed in the T2D group (P=0.61) either. T2D patients reported being markedly more restrained when eating than did the T1D patients (P=0.002), and their restraint increased along with their BMI (P<0.001). Patients who overate or binged also reported greater general hunger (P=0.02) and disinhibition (P=0.003) than did the NORM patients. CONCLUSION AEB is present in French diabetic patients at levels that are probably higher than among the general population. These results highlight the need for: (1) greater awareness among diabetes clinicians of the problem; (2) regular screening of diabetic patients for AEB; and (3) adaptation of therapeutic and dietary recommendations for this patient subgroup.
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Affiliation(s)
- M Ryan
- Pôle de maladies métaboliques et médecine interne, EDN-CHU d'Angers, 4, rue Larrey, 49033 Angers cedex, France
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Tierney S, Deaton C, Whitehead J. Caring for people with type 1 diabetes mellitus engaging in disturbed eating or weight control: a qualitative study of practitioners’ attitudes and practices. J Clin Nurs 2008; 18:384-90. [DOI: 10.1111/j.1365-2702.2008.02434.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takii M, Uchigata Y, Tokunaga S, Amemiya N, Kinukawa N, Nozaki T, Iwamoto Y, Kubo C. The duration of severe insulin omission is the factor most closely associated with the microvascular complications of Type 1 diabetic females with clinical eating disorders. Int J Eat Disord 2008; 41:259-64. [PMID: 18095311 DOI: 10.1002/eat.20498] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate which features of eating disorders are associated with retinopathy and nephropathy in Type 1 diabetic females with clinical eating disorders. METHOD Participants were 109 Type 1 diabetic females with clinical eating disorders diagnosed by the structured clinical interview for DSM-IV (bulimia nervosa [n = 70], binge-eating disorder [n = 28], anorexia nervosa [n = 7], and eating disorder not otherwise specified [n = 4]). Retinopathy and nephropathy were screened and demographic, medical, and eating disorder related factors were investigated. To identify the factors associated with each complication, logistic regression analysis was done. RESULTS Duration of severe insulin omission and duration of Type 1 diabetes were significantly associated with retinopathy (odds ratios = 1.35 and 1.23, respectively) and nephropathy (odds ratio = 1.35 and 1.21, respectively) in multivariate regression analyses. CONCLUSION Of the various problematic behavioral factors related to eating disorders, the duration of severe insulin omission was the factor most closely associated with the retinopathy and nephropathy of Type 1 diabetic females with clinical eating disorders by multivariate analysis. This finding may help patients who deliberately omit insulin become aware of medical risk of insulin omission.
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Affiliation(s)
- Masato Takii
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Moreira T, Malec E, Ostenson CG, Efendic S, Liljequist S. Diabetic type II Goto-Kakizaki rats show progressively decreasing exploratory activity and learning impairments in fixed and progressive ratios of a lever-press task. Behav Brain Res 2007; 180:28-41. [PMID: 17408764 DOI: 10.1016/j.bbr.2007.02.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 02/12/2007] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
Learning and memory impairments associated with diabetes have been reproduced in rodent models of diabetes type I, but few studies have been performed in spontaneously type II diabetic rodents. The study of type II diabetic rats such as the Goto-Kakizaki (GK) rat is of advantage when characterizing the development of cognitive impairments specifically caused by the progression of the disease and not by its treatment. We thus hypothesized that GK rats might display learning impairments when compared to non-diabetic Wistar rats. In the present study, we employed a lever-press task, a behavioural paradigm which allows the study of response-reinforcement learning, discrimination of a rewarding lever (using a two-choice positional discrimination task), and the ability to increase operant behaviour when requirements for reward increase (using a progressive ratio [PR]). In parallel, locomotor activity was compared between strains to assess exploratory activity and behavioural habituation to a novel environment. Diabetic GK rats made significantly less lever-presses with increasing fixed ratios and, throughout the sessions, a trend for increased selection errors was observed in these animals. In addition, a significant reduction in the maximum number of lever-presses made by GK rats was observed during the PR sessions. Locomotor activity of GK rats was higher on the first day of exploration but significantly decreased with familiarization to the environment. The present results suggest that the diabetic-like symptomatology in GK rats led to a reduction of exploratory activity and of lever-pressing during fixed and progressive ratio schedules, likely caused by learning impairments.
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Affiliation(s)
- Tiago Moreira
- Department of Clinical Neuroscience, Division of Drug Dependence Research, Building L4a:00, Karolinska Institutet, SE-17176 Stockholm, Sweden.
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Papelbaum M, Appolinário JC, Moreira RDO, Duchesne M, Kupfer R, Coutinho WF. Distribuição de transtornos alimentares em indivíduos com diabetes melito do tipo 1 e do tipo 2: descrição de dois casos. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-81082007000100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A presença de alterações do comportamento alimentar parece estar aumentada no diabetes melito (DM). Entretanto, a distribuição das diversas categorias de transtornos alimentares tende a se distinguir de acordo com a fisiopatologia do diabetes. O objetivo dessa apresentação é discutir dois casos distintos de ocorrência de transtornos alimentares no DM do tipo 1 (DM1) e no DM do tipo 2 (DM2). A paciente A é do sexo feminino, tem 19 anos e apresenta DM1 desde os 13 anos. Evidenciava sintomas depressivos proeminentes e, há 2 anos, passou a apresentar episódios de compulsão alimentar seguidos de vômitos auto-induzidos e omissão das doses de insulina com o objetivo de evitar ganho de peso. Em função desse comportamento, apresentou diversas internações associadas a uma piora do controle glicêmico. Após o uso de fluoxetina, houve remissão da psicopatologia alimentar e melhora do controle do DM. A paciente B possui 42 anos e é portadora do DM2 há 6 anos. Apresenta obesidade grau II e vinha exibindo, antes mesmo do diagnóstico do DM2, episódios de compulsão alimentar na ausência de comportamentos compensatórios, que prejudicavam o controle metabólico do diabetes. Foi iniciada fluoxetina até a dose de 60 mg/dia, com remissão do descontrole alimentar, perda ponderal e redução da hemoglobina glicosilada. A incidência de transtornos alimentares no DM1 estaria associada com um aumento da preocupação com a forma corporal e a possibilidade da omissão do uso da insulina como comportamento compensatório. No DM2, a obesidade seria um dos fatores associados ao desenvolvimento da psicopatologia alimentar.
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Affiliation(s)
- Marcelo Papelbaum
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | - José Carlos Appolinário
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | | | - Mônica Duchesne
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | - Rosane Kupfer
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro
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Zerbe KJ. Eating disorders in the 21st century: identification, management, and prevention in obstetrics and gynecology. Best Pract Res Clin Obstet Gynaecol 2007; 21:331-43. [PMID: 17208049 DOI: 10.1016/j.bpobgyn.2006.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Eating disorders are extremely common and carry a high degree of medical and psychiatric morbidity. These disorders are challenging to treat because many patients deny their symptoms, have poor motivation to change, and can become frustrating to the clinician. Case identification based upon suggested screening questions and ongoing management of medical consequences are important roles for the obstetrician/gynecologist involved in the care of these patients. This chapter discusses the benefits and limitations of contemporary treatment, special populations at risk (e.g. athletes, diabetics), and screening guidelines for office practice. Signs, symptoms, laboratory abnormalities, and the perils of associated psychiatric illness are briefly reviewed. Patients do respond to a comprehensive, integrated treatment plan that includes nutritional stabilization, psychotherapy, and pharmacotherapy. Collaboration between all professionals involved in the patient's care is essential for state-of-the-art care. Those patients who become pregnant or wish to become pregnant pose certain additional treatment considerations. Ongoing and future research aimed at understanding how eating disorders develop - and may be prevented by early identification and education - will result in enhanced knowledge of these life-threatening and often chronic illnesses in the 21st century.
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Affiliation(s)
- Kathryn J Zerbe
- Department of Psychiatry, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Code OPO2, Portland, Oregon 97239-3098, USA.
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Abstract
This study was undertaken to consider the psychological aspect of diabetes with regard to improving clinical outcomes. The review was limited to literature reports on the causes, solutions, and treatments of some common psychological problems known to complicate diabetes management. A literature search was undertaken using Pub-Med, CINAHL, Proquest, Elsevier, Blackwell Synergy, Ovid, Ebsco, Rose net, and Google websites, including studies published in English journals between 1995 and 2006. Therefore about 88 articles were selected based on the inclusion criteria. In earlier studies, relatively little empirical research was found to substantiate the effect of psychological counseling in complicated diabetes. The greatest deficits were seen in areas of mental health, self-esteem parent impact, and family cohesion. There were some different factors, which influence the psychological aspect of diabetic patients, such as age, gender, place of living, familial and social support, motivation, energy, life satisfaction, and lifestyle. There are various types of solutions for coping with the psychological problems in diabetic clients. The most essential solution lies in educating the patients and healthcare providers on the subject. Before initiating each educational intervention, a thorough assessment would be crucial. Treatment plans may benefit from cognitive behavior therapy (CBT), behavior family therapy, improving family communication, problem-solving skills, and providing motivation for diabetic patients. Moreover, it seems that the close collaboration between diabetologists and psychologists would be fruitful.
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Affiliation(s)
- Fatemeh Adili
- Endocrinology and Metabolism Research Centre of Tehran University of Medical Sciences, 5th Floor, Dr. Shariati Hospital, North Kargar Ave., Tehran 14114, Iran.
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Meneghini LF, Spadola J, Florez H. Prevalence and associations of binge eating disorder in a multiethnic population with type 2 diabetes. Diabetes Care 2006; 29:2760. [PMID: 17130226 DOI: 10.2337/dc06-1364] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Maekawa F, Fujiwara K, Kohno D, Kuramochi M, Kurita H, Yada T. Young adult-specific hyperphagia in diabetic Goto-kakizaki rats is associated with leptin resistance and elevation of neuropeptide Y mRNA in the arcuate nucleus. J Neuroendocrinol 2006; 18:748-56. [PMID: 16965293 DOI: 10.1111/j.1365-2826.2006.01470.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study aimed to examine whether hyperphagia, which is frequently observed in type 1 diabetic patients and model animals, also occurs in type 2 diabetic Goto-Kakizaki (GK) rats and, if so, to explore underlying abnormalities in the hypothalamus. GK rats at postnatal weeks 6-12, compared to control Wistar rats, exhibited hyperphagia, hyperglycaemia, hyperleptinemia and increased visceral fat accumulation, whereas body weight was unaltered. The ability of leptin to suppress feeding was reduced in GK rats compared to Wistar rats of these ages. In GK rats, leptin-induced phosphorylation of signal transducer and activator of transcription 3 was significantly reduced in the cells of the hypothalamic arcuate nucleus (ARC), but not of the ventromedial hypothalamus, whereas the mRNA level of functional leptin receptor was unaltered. By real-time polymerase chain reaction and in situ hybridisation, mRNA levels of neuropeptide Y, but not pro-opiomelanocortin and galanin-like peptide, were significantly increased in the ARC of GK rats at 11 weeks, but not 26 weeks. Following i.c.v. injection of a NPY Y1 antagonist, 1229U91, the amount of food intake in GK rats was indistinguishable from that in Wistar rats, thus eliminating the hyperphagia of GK rats. These results demonstrate that young adult GK rats display hyperphagia in association with leptin resistance and increased NPY mRNA level in the ARC.
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Affiliation(s)
- F Maekawa
- Department of Physiology, Division of Integrative Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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van de Laar FA, van de Lisdonk EH, Lucassen PLBJ, Stafleu A, Mulder J, van den Hoogen HJM, Rutten GEHM, van Weel C. Eating behaviour and adherence to diet in patients with Type 2 diabetes mellitus. Diabet Med 2006; 23:788-94. [PMID: 16842485 DOI: 10.1111/j.1464-5491.2006.01885.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To assess restrained, emotional and external eating behaviour in patients newly diagnosed with Type 2 diabetes compared with the general population, and to assess the relationship of eating behaviour to changes in fat and energy. METHODS We assessed emotional, external, and restrained eating behaviour and measured fat and energy intake in a cohort of patients with newly diagnosed Type 2 diabetes. Data from a comparable sample of the general population served as reference figures. We calculated correlation coefficients of the three different types of eating behaviour at diagnosis between: (i) energy and fat intake at diagnosis and (ii) changes in energy and fat intake between diagnosis and both 8 weeks and 4 years later. In addition, we used a stepwise multiple regression model with energy and fat intake or changes in energy and fat intake as dependent variables. RESULTS The distribution of the three types of eating behaviour was similar in patients with Type 2 diabetes and the general population. Emotional and external eating was associated with increased intake of energy and fat. Conversely, restrained eating showed an inverse correlation with energy and fat intake. External eating, but not emotional eating, showed a statistically significant relation with a decrease in energy intake in women. We found no statistically significant correlations between eating behaviour (measured at diagnosis) and changes in energy and fat intake between diagnosis and 4 years. CONCLUSIONS Patients newly diagnosed with Type 2 diabetes have similar eating behaviour compared with the general population. At diagnosis, external eating behaviour and emotional eating behaviour are associated with high-energy intake and restrained eating behaviour with low-energy intake. Women with high scores for emotional eating behaviour seem to be less able to make initial dietary changes after being diagnosed and having received dietary advice.
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Affiliation(s)
- F A van de Laar
- Radboud University Nijmegen medical Center, Department of General Practice, Nijmegen, The Netherlands.
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Yannakoulia M. Eating behavior among type 2 diabetic patients: a poorly recognized aspect in a poorly controlled disease. Rev Diabet Stud 2006; 3:11-6. [PMID: 17491707 PMCID: PMC1783576 DOI: 10.1900/rds.2006.3.11] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nutrition intervention is an integral part of type 2 diabetes care. Dietary management entails a series of eating behavior changes regarding meal planning, food selection, food preparation, dining out, portion control, as well as appropriate responses to eating challenges. Diabetic patients encounter several difficulties in complying with the dietary regime. They exhibit restrictive eating behaviors, they express feelings of dietary deprivation, and rigid dietary control is perceived as the only way to a proper diet and weight management. However, pressure to conform to nutritional recommendations may render diabetics more prone to dietary under-reporting. Binge eating, restraint and body dissatisfaction frequently occur among these patients. Health professionals, therefore, need to take into account these difficulties in their collaboration with the patients in order to improve the effectiveness of nutrition intervention.
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Affiliation(s)
- Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, El. Venizelou 70, 17671 Athens, Greece.
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Cerrelli F, Manini R, Forlani G, Baraldi L, Melchionda N, Marchesini G. Eating behavior affects quality of life in type 2 diabetes mellitus. Eat Weight Disord 2005; 10:251-7. [PMID: 16755169 DOI: 10.1007/bf03327492] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We evaluated the prevalence of disordered eating behavior in 168 unselected outpatients with type 2 diabetes mellitus (T2DM) and the effects on the health related quality of life (HRQL). Subjects in generally good glycemic control, treated by diet or oral hypoglycemic agents (58% M; 63.8+/-SD 10.1 years; BMI, 29.7+/-5.9 kg/m2) completed self-administered questionnaires for HRQL (SF-36) and eating behavior [(Three-Factor Eating Questionnaire (TFEQ); Binge Eating Scale (BES)]. Data on HRQL were computed as effectsizes in comparison to population norm. The prevalence of altered TFEQ scales was not different between genders, and varied between 22.1% (disinhibition) and 41.4% (restriction), but only 6.7% had a positive BES score. Age (OR, 0.58 for decade; 95% CI, 0.39-0.87), duration of diabetes (OR, 1.33 for 5 years; 1.01-1.74) and BMI (OR, 1.11; 1.04-1.18) were predictive for the presence of disinhibition. BMI also predicted hunger (OR, 1.16; 1.08-1.25). SF36 domains were not different in relation to positive BES. Disinhibition at TFEQ was significantly associated with poor social functioning (p=0.018) and role-emotional (p=0.022), whereas hunger was associated with poor physical functioning (p=0.010), role-physical (p=0.0014), social functioning (p=0.015) and role-emotional (p=0.0001). Metabolic control, duration of diabetes, and the presence of complications were not associated with HRQL. A disordered eating behavior may be present in T2DM patients, and is associated with poor HRQL. This condition must be considered for an olistic approach to weight control.
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Affiliation(s)
- F Cerrelli
- Unit of Metabolic Diseases, Department of Internal Medicine and Gastroenterology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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Kelly SD, Howe CJ, Hendler JP, Lipman TH. Disordered eating behaviors in youth with type 1 diabetes. DIABETES EDUCATOR 2005; 31:572-83. [PMID: 16100333 DOI: 10.1177/0145721705279049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Eating disorders are a significant health problem for many adolescents and are described as occurring along a spectrum of symptoms including disordered eating behaviors and clinical eating disorders. Poor self-esteem and body image, intense fear of gaining weight or refusal to maintain weight, and purging unwanted calories are clinical features of some eating disorders. Type 1 diabetes is a chronic illness with marked insulin deficiency. Chronic hyperglycemia creates a state of glucosuria with subsequent weight loss. Diabetes treatment focuses on intensive daily management of blood glucose by balancing insulin, food intake, and physical activity. Insulin omission offers an easy method for the purging of unwanted calories. The combination of these 2 illnesses is potentially deadly and also leads to an increased risk of poor diabetes outcomes. This includes poor metabolic control (measured by elevated hemoglobin A1C), increased risk of diabetic ketoacidosis, and microvascular complications such as retinopathy and nephropathy. Diabetes clinicians should be aware of the potential warning signs in an adolescent with diabetes as well as assessment and treatment options for eating disorders with concomitant type 1 diabetes. This article reviews the available data on the prevalence, screening tools, assessment guidelines, and treatment options for eating disorders in youth with type 1 diabetes.
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Affiliation(s)
- Sarah Dion Kelly
- The Diabetes Center for Children, Division of Endocrinology, the Children’s Hospital of Philadelphia, Pennsylvania (Ms Kelly, Ms Howe, Dr Lipman)
| | - Carol J Howe
- The Diabetes Center for Children, Division of Endocrinology, the Children’s Hospital of Philadelphia, Pennsylvania (Ms Kelly, Ms Howe, Dr Lipman)
| | | | - Terri H Lipman
- The University of Pennsylvania, School of Nursing, Philadelphia (Dr Lipman)
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Garrison MM, Katon WJ, Richardson LP. The impact of psychiatric comorbidities on readmissions for diabetes in youth. Diabetes Care 2005; 28:2150-4. [PMID: 16123482 DOI: 10.2337/diacare.28.9.2150] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Comorbid psychiatric disorders have been associated with poorer disease outcomes in diabetic youth. Less is known, however, about the relationship between psychiatric disorders and repeat hospitalizations for youth with diabetes. RESEARCH DESIGN AND METHODS We performed a retrospective cohort study using data from the Pediatric Health Information System, which included detailed discharge data from 37 non-competing children's hospitals in the U.S. Using logistic regression, we examined whether the presence of coded diagnoses for internalizing or externalizing disorders at an index hospitalization for diabetes was associated with increased risk for rehospitalization during follow-up (duration of follow-up ranged from 3 to 24 months). The analysis was stratified by age-groups, and we controlled for potential confounders including sex, age, race/ethnicity, type 1 versus type 2 diabetes, Medicaid status, intensive care unit utilization, length of stay during index admission, and duration of follow-up. RESULTS Among adolescents aged 13-18, internalizing disorders were associated with significantly increased odds of rehospitalization (odds ratio 1.79 [95% CI 1.27-2.52]); the point estimate for externalizing disorders was similar, but the finding was not statistically significant at the alpha = 0.05 level (1.74 [0.96-3.15]). No significant association between psychiatric diagnoses and odds of repeat hospitalization was observed in diabetic children aged 5-12 years. CONCLUSIONS Internalizing disorders are associated with increases in repeat hospitalizations for diabetes among adolescents. Future research is needed to explore the reasons for this finding, such as degree to which treatment nonadherence mediates this relationship and whether appropriate treatment of internalizing disorders results in improved diabetes outcomes and decreased readmissions.
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Affiliation(s)
- Michelle M Garrison
- Child Health Institute, University of Washington, Box 354920, Seattle Washington 98195-4920, USA.
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Papelbaum M, Appolinário JC, Moreira RDO, Ellinger VCM, Kupfer R, Coutinho WF. Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients. BRAZILIAN JOURNAL OF PSYCHIATRY 2005; 27:135-8. [PMID: 15962139 DOI: 10.1590/s1516-44462005000200012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A few studies have shown high rates of eating disorders and psychiatric morbidity in patients with type 2 diabetes mellitus. OBJECTIVE Disturbed eating behavior and psychiatric comorbidity in a sample of T2DM patients. METHODS Seventy type 2 diabetes mellitus patients between 40 and 65 years of age (mean, 52.9 +/- 6.8) from a diabetes outpatient clinic were sequentially evaluated. The Structured Clinical Interview for DSM-IV, Binge Eating Scale and Beck Depression Inventory were used to assess eating disorders and other psychiatric comorbidity. In addition to the descriptive analysis of the data, we compared groups divided based on the presence of obesity (evaluated by the body mass index) or an eating disorder. RESULTS Twenty percent of the sample displayed an eating disorder. Binge eating disorder was the predominant eating disorder diagnosis (10%). Overall, the group of obese patients with type 2 diabetes mellitus presented rates of psychiatric comorbidity comparable to those seen in their nonobese counterparts. However, the presence of an eating disorder was associated with a significant increase in the frequency of anxiety disorders (57.1% x 28.6%; p = 0.044). CONCLUSIONS In our study sample, the occurrence of eating disorders was increased compared to rates observed in the general population, with the predominance of binge eating disorder. The presence of an eating disorder in type 2 diabetes mellitus patients was associated with higher rates of anxiety disorders.
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Affiliation(s)
- Marcelo Papelbaum
- Obesity and Eating Disorders Group, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
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Abstract
Apparently simple questions can easily be misunderstood or cause offence in disadvantaged groups. But such problems can be avoided by careful design, piloting, and administration
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Affiliation(s)
- Petra M Boynton
- Department of Primary Care and Population Sciences, University College London, London N19 5LW.
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Grylli V, Hafferl-Gattermayer A, Schober E, Karwautz A. Prevalence and clinical manifestations of eating disorders in Austrian adolescents with type-1 diabetes. Wien Klin Wochenschr 2004; 116:230-4. [PMID: 15143861 DOI: 10.1007/bf03041052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To investigate prevalence and clinical manifestations of DSM-IV clinical eating disorders and subsyndromal eating problems among adolescents with type-1 diabetes. METHOD A clinical sample of 251 adolescents with type-1 diabetes was recruited from multiple centres. Of these adolescents, 199 (96 girls and 103 boys--79.3% participation rate) with a mean age of 14.1 years (SD: 2.6) were screened for eating disorders and then underwent DSM-IV-based clinical assessment of eating disorders by interview. RESULTS 11.5% of the girls and none of the boys with type-1 diabetes had DSM-IV eating disorders, whereas 13.5% of the girls and 1% of the boys had subsyndromal problems of eating and shape. Girls with both type-1 diabetes and a clinical or subclinical eating disorder had a significantly higher body-mass index than those without eating problems. CONCLUSION This Austrian study supports cumulative international evidence that among youths with type-1 diabetes, adolescent girls and especially those having a higher body mass are particularly vulnerable for manifesting pathology of eating, weight and shape. Thus, this particular population requires screening of eating behaviour and relevant psychopathology, close monitoring, and psychosocial interventions through cooperative efforts of specialised centres.
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Affiliation(s)
- Vasileia Grylli
- Eating Disorders Unit, University Clinic of Neuropsychiatry of Childhood and Adolescence, Medical University of Vienna, Vienna, Austria
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