1
|
Dean YE, Motawea KR, Aslam M, Pintado JJL, Popoola‐Samuel HAO, Salam M, Dundi POR, Donaldy W, Aledani EM, Alqiqie Z, Sultana N, Mohamed ARH, Elalem A, Syeda STH, Mohamed MS, Assal MW, Attia NM, Hagar H, Abdelaziz HA, Subedi A, Elbahaie A, Hazimeh Y, Aiash H. Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis. Endocrinol Diabetes Metab 2024; 7:e473. [PMID: 38597269 PMCID: PMC11005101 DOI: 10.1002/edm2.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Previous meta-analyses have shown mixed results regarding the association between eating disorders (EDs) and type 1 diabetes mellitus (T1DM). Our paper aimed to analyse different EDs and disordered eating behaviours that may be practiced by patients with T1DM. METHODS A literature search of PubMed, Scopus and Web of Science was conducted on 17 January 2023, using the key terms "T1DM," "Eating Disorders" and "Bulimia." Only observational controlled studies were included. The Revman software (version 5.4) was used for the analysis. RESULTS T1DM was associated with increased risk of ED compared with nondiabetic individuals (RR = 2.47, 95% CI = 1.84-3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18-6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18-1.98, p-value = 0.001). Our analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91-4.12, p-value < 0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27-3.23, p-value = 0.003). Prevalence of insulin omission/misuse was 10.3%; diabetic females demonstrated a significantly higher risk of insulin omission and insulin misuse than diabetic males. CONCLUSION Our study establishes a significant and clear connection between EDs and T1DM, particularly bulimia and binge eating, with T1DM. Moreover, female diabetics are at higher risk of insulin misuse/omission. Early proactive screening is essential and tailored; comprehensive interventions combining diabetes and ED components are recommended for this population, with referral to a specialised psychiatrist.
Collapse
Affiliation(s)
- Yomna E. Dean
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | - Muaaz Aslam
- Shaikh Khalifa Bin Zayed Al‐Nahyan Medical and Dental CollegeLahorePakistan
| | | | | | | | | | | | | | | | | | | | - Amir Elalem
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | | | | | | | - Hanan Hagar
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | | | - Anuj Subedi
- Prithvi Narayan Community HospitalGorkhaNepal
| | | | | | - Hani Aiash
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
| |
Collapse
|
2
|
Ip EJ, Doroudgar S, Salehi A, Salehi F, Najmi M. Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus. Endocr Pract 2023; 29:849-854. [PMID: 37567472 DOI: 10.1016/j.eprac.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. METHODS A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. RESULTS Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). CONCLUSION Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.
Collapse
Affiliation(s)
- Eric J Ip
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California; Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Aava Salehi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Fojan Salehi
- Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Mitra Najmi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California.
| |
Collapse
|
3
|
Vasiliu O. An integrative model as a step toward increasing the awareness of eating disorders in the general population. Front Psychiatry 2023; 14:1184932. [PMID: 37205977 PMCID: PMC10188970 DOI: 10.3389/fpsyt.2023.1184932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like "food addiction," "orthorexia nervosa," or "emotional eating disorder" still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).
Collapse
|
4
|
Goldshmid AE, Balakshina NA, Amosova MV, Poluboyarinova IV, Fadeev VV. The combination of type 1 diabetes and eating disorder during pregnancy. DIABETES MELLITUS 2022. [DOI: 10.14341/dm12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The problem of eating disorders currently holds a special place in clinical practice. Bulimia nervosa is one of the main forms of eating disorders, characterized by the difficulty in its treatment and a long, recurrent course. Eating disorders are common in patients with type 1 diabetes mellitus (T1D), especially in adolescent girls.In this article, we present a clinical case of a patient with T1D and bulimia nervosa, which developed before the manifestation of T1D and progressed against its background. The patient is overly concerned with controlling body weight, specifically restricted the intake of carbohydrates, forcibly caused vomiting. During pregnancy fasting ketonuria («low-carb ketone») was repeatedly detected. The minimum weight was 37 kg (BMI 15.2 kg/m2). Particular interest of this case is the course of pregnancy, which ended in the antenatal death. The possible cause could be the restriction on carbohydrate food and prolonged stay in ketosis, that might lead to the development of pregnancy pathology. Additional examination also revealed multiple complications of diabetes and recurrent depressive disorder, which requires conjoint monitoring by an endocrinologist and a psychiatrist.Combination of T1D and eating disorder in a pregnant patient should be considered as an atypical course of the disease.
Collapse
Affiliation(s)
- A. E. Goldshmid
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. A. Balakshina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. V. Amosova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - V. V. Fadeev
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| |
Collapse
|
5
|
Determining the risk of diabulimia and its relationship with diet quality and nutritional status of adolescents with type 1 diabetes. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
6
|
Ferrero Franco R, Garcia de Lorenzo A, Gonzalez Castro A. Diabulimia: An updated perspective. ENFERMERIA CLINICA (ENGLISH EDITION) 2021; 31:396-397. [PMID: 34116976 DOI: 10.1016/j.enfcle.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Raquel Ferrero Franco
- Grado en Enfermería, Gerencia de Atención Primaria del Servicio Cántabro de Salud, Spain
| | - Abelardo Garcia de Lorenzo
- Miembro de Honor de la Academia Española de Nutrición y Dietética, Catedrático de Medicina Intensiva, Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma de Madrid, Director de la Cátedra FUAM-Fundación Abbott de Medicina Crítica y Metabolismo, Jefe del Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Alejandro Gonzalez Castro
- Médico Especialista en Medccina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| |
Collapse
|
7
|
Hall R, Keeble L, Sünram-Lea SI, To M. A review of risk factors associated with insulin omission for weight loss in type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:606-616. [PMID: 34121470 PMCID: PMC8264633 DOI: 10.1177/13591045211026142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.
Collapse
Affiliation(s)
- Rebecca Hall
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | - Leanna Keeble
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | | | - Michelle To
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| |
Collapse
|
8
|
Lica MM, Papai A, Salcudean A, Crainic M, Covaciu CG, Mihai A. Assessment of Psychopathology in Adolescents with Insulin-Dependent Diabetes (IDD) and the Impact on Treatment Management. CHILDREN (BASEL, SWITZERLAND) 2021; 8:414. [PMID: 34069480 PMCID: PMC8159087 DOI: 10.3390/children8050414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Assessing mental health in children and adolescents with insulin-dependent diabetes (IDD) is an issue that is underperformed in clinical practice and outpatient clinics. The evaluation of their thoughts, emotions and behaviors has an important role in understanding the interaction between the individual and the disease, the factors that can influence this interaction, as well as the effective methods of intervention. The aim of this study is to identify psychopathology in adolescents with diabetes and the impact on treatment management. A total of 54 adolescents with IDD and 52 adolescents without diabetes, aged 12-18 years, completed APS-SF (Adolescent Psychopathology Scale-Short Form) for the evaluation of psychopathology and adjustment problems. There were no significant differences between adolescents with diabetes and control group regarding psychopathology. Between adolescents with good treatment adherence (HbA1c < 7.6) and those with low treatment adherence (HbA1c > 7.6), significant differences were found. In addition, results showed higher scores in girls compared with boys with IDD with regard to anxiety (GAD), Major Depression (DEP), Post-Traumatic Stress Disorder (PTSD), Eating Disturbance (EAT), Suicide (SUI) and Interpersonal Problems (IPP). No significant differences were found regarding the duration of the disease. Strategies such as maladaptive coping, passivity, distorted conception of the self and the surrounding world and using the negative problem-solving strategies of non-involvement and abandonment had positive correlation with poor glycemic control (bad management of the disease). The study highlighted the importance of promoting mental health in insulin-dependent diabetes management.
Collapse
Affiliation(s)
- Maria Melania Lica
- Department of Psychiatry, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tirgu Mures, 540139 Targu Mures, Romania; (M.M.L.); (A.P.); (A.S.); (M.C.)
| | - Annamaria Papai
- Department of Psychiatry, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tirgu Mures, 540139 Targu Mures, Romania; (M.M.L.); (A.P.); (A.S.); (M.C.)
| | - Andreea Salcudean
- Department of Psychiatry, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tirgu Mures, 540139 Targu Mures, Romania; (M.M.L.); (A.P.); (A.S.); (M.C.)
| | - Maria Crainic
- Department of Psychiatry, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tirgu Mures, 540139 Targu Mures, Romania; (M.M.L.); (A.P.); (A.S.); (M.C.)
| | - Cristina Georgeta Covaciu
- Clinical Emergency Hospital for Children‒Child and Adolescent Psychiatry, 400000 Cluj Napoca, Romania;
| | - Adriana Mihai
- Department of Psychiatry, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tirgu Mures, 540139 Targu Mures, Romania; (M.M.L.); (A.P.); (A.S.); (M.C.)
- IPPD Institute of Psychotherapy and Personal Development, 540044 Tirgu Mures, Romania
| |
Collapse
|
9
|
Ferrero Franco R, Garcia de Lorenzo A, Gonzalez Castro A. Diabulimia: An updated perspective. ENFERMERIA CLINICA 2021; 31:S1130-8621(21)00053-X. [PMID: 33750657 DOI: 10.1016/j.enfcli.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Raquel Ferrero Franco
- Grado en Enfermería, Gerencia de Atención Primaria del Servicio Cantabro de Salud, España
| | - Abelardo Garcia de Lorenzo
- Miembro de Honor de La Academia Española de Nutricion y Dietetica. Catedrático de Medicina Intensiva. Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma de Madrid. Director de la Cátedra FUAM-Fundación Abbott de Medicina Crítica y Metabolismo. Jefe del Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, España
| | - Alejandro Gonzalez Castro
- Médico especialista en Medc¡cina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| |
Collapse
|
10
|
Coleman SE, Caswell N. Diabetes and eating disorders: an exploration of 'Diabulimia'. BMC Psychol 2020; 8:101. [PMID: 32967730 PMCID: PMC7513317 DOI: 10.1186/s40359-020-00468-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
Background ‘Diabulimia’ is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research. Methods Forty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis. Results The average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction. Conclusions Overall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider.
Collapse
Affiliation(s)
| | - Noreen Caswell
- Senior Lecturer, School of Psychology, University of Central Lancashire, Preston, UK
| |
Collapse
|
11
|
Wisting L, Snoek F. Terminology matters: 'diabulimia' is insufficient to describe eating disorders in individuals with Type 1 diabetes. Diabet Med 2020; 37:1075-1076. [PMID: 31418895 DOI: 10.1111/dme.14108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- L Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Center, Oslo, Norway
| | - F Snoek
- Department of Medical Psychology, Amsterdam Public Health research Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Sokunbi MO. Using real-time fMRI brain-computer interfacing to treat eating disorders. J Neurol Sci 2018; 388:109-114. [DOI: 10.1016/j.jns.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
|