Eating disorders in adolescent females with type 1 diabetes mellitus, a controlled three-site study

grantor: University of TorontoBody dissatisfaction and dieting have become increasingly common in young women in Western countries, and are often associated with a cycle of binge-eating, further dietary restriction, and purging behaviours. In females with type 1 diabetes mellitus, this cycle may be triggered or amplified due to several aspects of diabetes and its management. Eating disorders have been found to be relatively common in adolescent females with type 1 diabetes and are associated with impaired metabolic control and an increased risk of microvascular complications. However, controversy persists as to whether eating disorders occur more frequently in females with diabetes than in their non-diabetic peers. A 3-site, 2-stage cross-sectional study was conducted to compare the frequency of eating disorders in 356 adolescent females with type 1 diabetes (mean age 15 ± 2 years) to 1098 age-matched non-diabetic controls. Eating disorders were assessed using self-report screening measures followed by a standardized diagnostic interview for those scoring above predetermined cut-off levels. Metabolic control in diabetes subjects was assessed by hemoglobin A1c. Eating disorders that met DSM-IV criteria were more prevalent in subjects with diabetes (10.1 percent) than in non-diabetic controls (4.5 percent, P < 0.001). Sub-threshold eating disorders were also more common in those with diabetes (13.8 percent) than in controls (7.6 percent, P < 0.001). Body mass index was higher in diabetes subjects (22.6 ± 3.8 kg/m 2) than controls (20.6 ± 3.3 kg/m2, P < 0.0001), and diabetes subjects with an eating disorder were older at diabetes onset than those without. At screening, insulin dosage manipulation to promote weight loss was reported by 11 percent of the subjects with diabetes, and by 42 percent of subjects diagnosed with a DSM-IV disorder. Mean hemoglobin A1c was higher in diabetes subjects with a DSM-IV eating disorder (9.4 ± 1.8 percent) than in those without (8.6 ± 1.6 percent, P = 0.004). DSM-IV and sub-threshold eating disorders were almost twice as common in adolescent females with type 1 diabetes as in their non-diabetic peers, and were associated with insulin manipulation for weight loss and impaired metabolic control.Ph.D