Co-morbid Diabetes and Eating Disorders - an exploration of prevalence, psychological correlates and diabetic control

This project is a sub study of the Norweagian Childhood Diabetes Registry and investigated disturbed eating behavior in type 1 diabetes. The prevalence rates of disturbed eating among 770 males and females with type 1 diabetes aged 11-19 years was 18% in the whole sample, 9% among males and 28% among females. The prevalence increased by age and weight, with approximately 50% of the females in the oldest age group (17-19 yrs) and highest BMI-category having a level of disturbed eating that should be investigated further. Patients with disturbed eating had higher HbA1c (poorer metabolic control) than patients without disturbed eating. In addition, we investigated frequency of insulin restriction and omission, a commonly used method for rapid weight loss. Insulin restriction was associated with higher HbA1c, thereby an increased risk of diabetes complications. The frequency of disturbed eating in T1D underlines the importance of early and annual screening for disturbed eating behaviors. Early identification and subsequent intervention might contribute to minimising the risk of serious diabetes complications. As part of this process we translated and validated the screening instrument "the Diabetes Eating Problem Survey - Revised) This questionnaire takes less than ten minutes to complete and is easy to interpret. This can enable the diabetes treatment team the possibility of intervening at an early stage. I siste artikkel så vi på hvordan psykososial variabler og grad av spisepatologi kunne påvirke metabolsk kontroll (HbA1c). Regresjonsmodellen fant at særlig "illness beliefs" kunne forklare en del av variansen i HbA1c.

Insulin Dependent Diabetes Mellitus (IDDM) is a chronic condition associated with serious physical and psychological sequelae. Disturbed eating behaviour (DEB) is characterised by restricted, excessive or chaotic food intake. Eating Disorders (EDs) are c haracterised by the above behaviours as well as compensatory behaviours such as purging and excessive exercise, and abnormal cognitions such as a morbid preoccupation with food, weight and shape and distortion of body image. In IDDM, a particularly proble matic compensatory behaviour is that of insulin omission. Up to 30-40 % of young women with IDDM exhibit a clinically significant ED - approximately a 10-fold increase over the normal population, with a dramatic increase in morbidity and mortality. Even DEBs pose a risk of serious physical complications. Given the severity of the co-morbidity and its apparent frequency, there is an urgent need to obtain accurate prevalence rates and to explore the associated psychopathology, with the long-term aim of en hancing treatment. The aims of the project are: i) to assess the prevalence of DEBs and EDs; and ii) to investigate the relationship between ED psychopathology, IDDM regulation and other mediating factors in young people with diabetes in Norway. To obt ain high-quality data requires the recruitment of a large and fully representative sample. Fortunately the design allows access to all patients with IDDM in Norway between 12-18 years. The findings of this study will clarify the prevalence of co-morbid IDDM, DEBs and EDs in Norway, throw light upon the associated psychopathology and will inform the development of more effective treatments.