Women with insulin-dependent diabetes mellitus (IDDM) complicated by eating disorders are at risk for exacerbated alterations in lipid metabolism

Abstract

Objective: To examine lipid parameters that are affected in women with insulin-dependent diabetes mellitus (IDDM) who engaged in disordered eating behaviours. Design: Randomized, unmatched. Setting: Tertiary care. Subjects: Ninety women (18–46 y) with IDDM. Interventions: Classification of subjects based on severity of eating disorder: clinical (n=14), subclinical (n=13) and control (n=63). Blood was analysed for glycosylated haemoglobin (HbA_1c) and serum for triglycerides and cholesterol. Carotenoid and tocopherol concentrations were analysed by high performance liquid chromatography (HPLC). Dietary intake was assessed by the National Cancer Institute food frequency questionnaire. Results: HbA_1c was significantly increased im women demonstrating clinical and subclinical symptoms compared to control (10.4±2.6, 10.0±1.5 and 8.3±1.6%, respectively, P<0.05). Triglyceride concentrations were significantly increased in women with subclinical eating disorders compared to controls. In women who intentionally omitted or reduced insulin, triglyceride cholesterol and HbA_1c were significantly increased compared to controls. Women with IDDM and eating disorders who exhibited bulimic behaviours consumed significantly more energy, total fat and cholesterol compared to controls and women with eating disorders who were restrained eaters. Conclusion: While IDDM is known to perturb lipid metabolism, these data demonstrate that eating disorders, in combination with IDDM, results in additional alterations in lipid metabolism. Sponsorship: Supported in part by the Storrs Agricultural Experiment Station, University of Connecticut Research Foundation and an NIH General Clinical Research Grant from the University of Connecticut Health Centre (M01RR06192).