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Pathogenesis and treatment of eating disorders associated with type 1 diabetes mellitus

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 612–613 (2007)Cite this article

Concurrence of eating disorders with type 1 diabetes mellitus (T1DM) is one of the most difficult issues in the management of diabetes. Anorexia nervosa and bulimia nervosa are disorders of unknown origin characterized by disturbed eating or weight-control behaviors that impair physical health or psychosocial functioning. Bulimia nervosa is particularly common among patients with T1DM and persists over long periods. This disorder correlates with poor glycemic control, microvascular complications, and disturbed social activities.1,2,3 Subclinical eating disorders associated with T1DM include binge eating and insulin misuse (concurrent rates of 35–52% and 5–40%, respectively). These eating disorders are also associated with poor disease outcome.1,2,3 A vicious cycle of disturbed eating behaviors, poor metabolic control, and psychological distress exists in both clinical and subclinical eating disorders. Although this cycle can lead to long-term complications, there is a paucity of research about therapeutic options. In this Viewpoint, we highlight the extrinsic and intrinsic risk factors associated with concurrent eating disorders and T1DM, and discuss development of effective treatments.

Research on the pathogenesis of concurrent eating disorders has concentrated on extrinsic risk factors.3 Predisposing factors include the demands of life with T1DM (dietary restraint, weight control, blood glucose control, metabolic instability, and long-term complications), inadequate coping styles (self-blaming and harm-avoidance behaviors), and disordered family functioning (poor communication and inadequate support system). Weight gain caused by insulin therapy and the consequent emotional distress (body dissatisfaction or the drive to be thin) are precipitating factors for patients with concurrent eating disorders. Mainstream opinion, therefore, posits the development of a vicious cycle whereby insulin therapy induces weight gain and subsequent emotional distress, which in turn can lead to disordered eating behaviors (insulin misuse or binge eating) in an effort to lose weight or reduce emotional distress.1,2,3

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Acknowledgements

The authors' work was supported by a research, grant from the Japanese, Ministry of Health, Labor, and Welfare.

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  1. D Yasuhara is the Chief of Clinical Research and A Inui is a Professor in the Department of Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,

    Daisuke Yasuhara & Akio Inui

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  1. Daisuke Yasuhara
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  2. Akio Inui
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Correspondence to Akio Inui.

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Yasuhara, D., Inui, A. Pathogenesis and treatment of eating disorders associated with type 1 diabetes mellitus. Nat Rev Endocrinol 3, 612–613 (2007). https://doi.org/10.1038/ncpendmet0582

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