34 IS DIABETES A PRECIPITANT OF EATING PATHOLOGY?

Abstract

Recent case reports have led to speculation that eating disorders (anorexia nervosa(AN), bulimia(B), & their partial syndromes) may occur with increased frequency in association with diabetes(IDDM) & that these disorders may contribute to poor glycemic control. We report preliminary results of a systematic study of adolescent females with IDDM, since this is the age group of girls at greatest risk for eating pathology. 58 girls (age 17.6 yr, range 15–22) with IDDM of > 1 yr duration (8.4 yr) underwent a battery of tests: a) Eating Disorders Inventory(EDI); b) Eating Attitudes Test(EAT-26); & c) HbA1 to assess glycemic control. 27 (46.6%) subjects scored above the cut-off points on the EAT-26 & EDI frequently associated with eating pathology. These individuals then underwent a psychiatric interview: a diagnosis of AN was made in 4.:subjects(6.9%); partial syndrome of AN in 2(3.4%); B in 4, & partial syndrome of B in 2. There was a strong correlation between HbAl & bulimic symptoms, in those with high scores on the bulimia subscale of the EDI(r=0.81,p<0.005); this correlation was even stronger in those with clinical evidence of B(r=0.93,p<0.00l). Clinically significant eating pathology was detected in 20% of this group of adolescent females with IDDM; this represents a 2–fold increase in eating disorders & 6–7–fold increase in AN compared to nondiabetic populations. The presence of eating pathology, particularly B, is associated with poor metabolic control. Thus IDDM may be a major risk factor for the development of eating disorders, which in turn impact negatively upon metabolic control & physical well-being.