Disturbed glucose metabolism puts these patients at greater risk.
Reprinted from Eating Disorders Review
September/October Volume 25, Number 5
Studies of patients with diabetes and eating disorders have typically examined young women with type 1 diabetes (DM), and a link between type 1 DM and disordered eating is clear. However, a group in Finland has recently added growing evidence on the link between type 2 DM and clinically significant binge-eating (Int J Eat Disord 2014; Jul 25. doi: 10.1002/eat.22334 [Epub ahead of print]). In addition, the authors suggest that disturbed glucose metabolism may contribute to the onset and maintenance of binge eating disorder (BED) and bulimia nervosa (BN).
Type 2 DM involves hyperglycemia, which leads to a wide array of complications, including peripheral neuropathy (loss of nerve sensation or pain), neuropathy affecting the eyes (which can lead to vision loss), and kidney failure. BED may increase the risk of type 2 DM, as well as other components of the metabolic syndrome, above and beyond obesity, perhaps due to increased oxidative and inflammatory stress.
Anu Raevuori, MD, PhD, and a team at the Hjelt Institute, University of Helsinki, Helsinki, Finland, studied all 2342 patients who were treated in the Eating Disorders Unit at Helsinki University Central Hospital over a 15-year period. Four controls were selected from a population registry, and were matched for age, sex, and place of residence. In the eating disorders group, 1260 persons were diagnosed with BN, 911 with AN, and 171 with BED.
National insurance records revealed which patients developed diabetes. The risk of type 2 diabetes was high among individuals treated either for BED or BN. By the end of the study, a third of those with BED had type 2 DM; the rate of type 2 DM both before and after treatment was very high. However, among patients with BN, the risk of type 2 DM was higher before treatment, and then fell afterward. At the end of the study, the lifetime prevalence of type 2 diabetes was 0.8% among AN patients, 4.4% for those with BN, but 33.9% for those with BED. The rates were significantly higher among men than women.
According to the authors, their results support the fact that disturbed glucose metabolism played a role in the onset and maintenance of BED and BN. They recommend that clinicians who treat patients with BED and BN consider their patients’ high risk of type 2 DM and impaired glucose metabolism, which are likely to affect a larger proportion of these patients. Disturbances in glucose response may be the underlying mechanism behind the high prevalence and incidence of type 2 DM among eating disorder patients. The authors suggest future studies to explore the relationship of binge-eating and impaired glucose metabolism in patients with eating disorders, and in their relatives.