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Objective binge-eating was found in nearly half the participants in a 3-day test.
Disordered eating has long been recognized as common among individual with type 1 diabetes (T1D), and includes traditional ED symptoms such as binge eating, restriction, and compensation through self-induced vomiting, as well as restricting insulin in an effort to control weight.
In a recent study of adults with TID, Duke University researchers showed that diabetes distress may be related to eating disordered behavior (J Eat Disord. doi.org/10.1185/s40337-019-0237-3). Dr. Ashley A Moskovich and colleagues also found that individuals who tend to have negative affect and diabetes distress before eating are at risk of objective binge-eating (OBE) at the next meal.
Dr. Moskovich notes that eating control could focus not merely on weight but also on prevention of short- and long-term complications of diabetes. Thus, a better understanding is needed.
Study design
The 83 participants in Dr. Moskovich’s study were part of a larger study investigating eating disorder symptoms among individuals with T1D (DiabetesCare. 2015; 38:2025; Psychosom Med. 2018; 20:222). The participants ranged in age from 18 to 65 years and had T1D without hypoglycemic unawareness or cognitive disabilities that would interfere with their ability to independently manage their diabetes. Methods were particularly rigorous: All study participants completed 3 days of ecological momentary assessment of mood and eating behavior using a telephone-based survey system. Blinded continuous glucose monitoring enabled the researchers to monitor glucose levels throughout the test period and to look a time relationships to EMA measures.
The authors reported that level of participation was very high and participants answered an average of 96% of the prompts and reported an average of 4 eating episodes per day.
The role of negative affect
Of the 1002 eating episodes reported by participants, 80 were determined to be OBE episodes, and 43% of the study participants binge-ate at least once during the 3-day assessment. The odds of OBE were higher among persons with higher levels of pre-meal negative affect and increased emotional distress and higher 2-hour postprandial blood glucose levels following OBE versus non-OBE episodes. Nearly half of the participants reported OBE events during the 3-day test period.
These results highlight OBE as an important problem in T1D, both psychologically and metabolically. They also confirm the relationship between negative affect and binge eating reported in the past.
The authors correctly note that interventions focusing on helping patients cope with negative affect, and specifically diabetes distress, may be helpful for T1D patients.