Predicting Disturbed Patterns of Eating Among Girls with Type 1 Diabetes

Early intervention to help girls with diabetes develop positive feelings about themselves might help protect them from developing disturbed eating behaviors, according to Dr. Denis Daneman and colleagues at the University of Toronto (Family Practice News, August 15, 2008).

Dr. Daneman and his co-workers have identified four specific and significant predictors of disturbed eating behaviors in girls with type 1 diabetes mellitus. These behaviors include: (1) concerns with weight and shape, (2) higher body mass index, (3) depressive symptoms, and (4) poor self-esteem related to their appearance (Diabetes Care, July 15, 2008).

A problem that affects 10% of young women with type 1 diabetes

Dr. Daneman noted that disordered eating is a huge problem among girls and young women with type 1 diabetes. Prior studies by his group and trials conducted in Scandinavia, the United Kingdom, France, and the U.S. indicate that 10% of girls with type 1 diabetes in their middle teens meet formal Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for an eating disorder. He added that the two major DSM-IV eating disorders most often related to type 1 diabetes are bulimia nervosa and eating disorders not otherwise specified (EDNOS). This is not the case with anorexia nervosa, however.

Instead, it is only by chance that anorexia nervosa occurs with diabetes type 1, he said. He added that despite the common practice of manipulating insulin to control weight, insulin manipulation isn’t listed in the eating disorders section of the DSM-IV.

Dr. Daneman and colleagues designed a study to identify factors that could predict the development of disturbed eating behavior as girls with type 1 diabetes move into the peak years of the risk of onset of such behaviors, ages 15 to 25. The prospective study followed 126 girls with type 1 diabetes, enrolled when they were 9 to 13 years of age. Once a year for 5 years, each girl was interviewed with the Child’s Eating Disorder Examination and self-report measures. At the time they entered the study, 25 girls already had abnormal eating behaviors, including dieting for weight control, self-induced vomiting, binge-eating episodes, or trying to control their weight by withholding their insulin, or by using laxatives, diuretics, or extensive exercise.

By the end of the 5-year study, 45 of the 101 girls who did not have disordered eating behaviors at baseline had developed a number of disturbed eating behaviors.

Counteracting the development of abnormal behaviors

One way to counteract the abnormal behaviors may be through the use of  early interventions designed to help girls with type 1 diabetes develop positive feelings about themselves, their weight and shape and their overall physical appearance, Dr. Daneman said.