Clinical features in insulin-treated diabetes with comorbid diabulimia, disordered eating behaviors and eating disorders

Abstract

Adherence to self-management and medication regimens is required to achieve blood glucose control in diabetic patients. Therefore, diabulimia, the deliberate insulin restriction/omission to lose weight, and other disordered eating behaviors (DEBs) or eating disorders (EDs), place these patients at risk of complications.

We aimed to establish the frequency of diabulimia, DEBs and EDs among patients with type 1 and 2 diabetes (T1DM and T2DM) and their association with other clinical features.

A total of 211 insulin-treated diabetic patients (13–55 years old) answered the Diabetes Eating Problem Survey-Revised (DEPS-R), a diabetes-specific screening tool for DEBs, and the Eating Disorders Inventory-3 (EDI-3). SCID-I modified according to DSM-5 criteria was used to diagnose EDs.

At the DEPS-R, 20.8% of the sample scored above the cutoff, more frequently females (P = 0.005), patients with T1DM (P = 0.045), with a diagnosis of ED (P < 0.001), positive to the EDI-3 (P ≤ 0.001), with physical comorbidities (P = 0.003), with HbA1c > 7% (P = 0.020). Combining data from the interview with the results at the DEPS-R, 60.2% of the sample presented diabulimia. Dividing the sample by gender, we found that diabulimic females more frequently used diet pills (P = 0.006), had significantly higher HbA1c (P = 0.019) and STAI-Y1 scores (P = 0.004). Other DEBs comprised dietary restraint (51.8% of the sample), binge eating (42.2%), vomiting (6.2%), diet pills (7.1%) or laxatives (1.9%) or diuretics use (4.3%). Overall, 21.8% of the sample, mostly females (P < 0.001) met criteria for at least one DSM-5 diagnosis of ED.

Diabetic patients, especially women, should be carefully monitored for the presence of diabulimia, BEDs and EDs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.