The impact of an eating disorder on diabetes

This study examined the effect that an eating disorder has on the management and complications of diabetes.

The focus on an eating pattern in type 1 diabetes (T1D) patients can result in an eating disorder such as anorexia or bulimia nervosa. In addition to binge eating, patients may inject less insulin to excrete calories and therefore prevent weight gain. These factors may have a negative impact on HbA1c (a measurement of average blood glucose levels over the past 3 months), the frequency of ketoacidosis and also the development of diabetic retinopathy. Diabetic ketoacidosis is a condition that occurs when the cells of the body do not get enough glucose for energy and the body begins to burn fat. Diabetic retinopathy is eye disease related to diabetes complications.

The authors aimed to evaluate what impact an eating disorder may have on type 1 diabetes. 

This study involved 52,215 T1D patients aged 8 to 30 years.  0.9% of these patients were diagnosed with an eating disorder: anorexia (0.27% patients); bulimia nervosa (0.12% patients); other eating disorder (0.51% patients). Patients were divided into 2 groups (those with an eating disorder and those without an eating disorder). HbA1c, occurrence of ketoacidosis, hospitalization and diabetic retinopathy were compared between both groups.

Patients with an eating disorder had a higher HbA1c (8.61% anorexia; 9.11% bulimia nervosa; 9% other eating disorder) compared to those who did not (8.29%). Patients with an eating disorder also had more frequent ketoacidosis events (0.9 – 1.3 events per person per a year) compared to those who did not (0.5 events per person per year). Hospitalizations were more frequent and length of stay was longer in those with an eating disorder. Patients with bulimia nervosa had a 2.5-fold higher risk of developing diabetic retinopathy, while patients in the other eating disorder group had a 1.4-fold higher risk compared to those without an eating disorder. Anorexia patients were not deemed ot have an increased risk.

This study concluded that an eating disorder has a negative impact on metabolic control, increases the frequency of diabetic ketoacidosis, the number of hospitalizations and increases the risk of diabetic retinopathy. 

Patients with an undiagnosed eating disorder were not included and so the prevalence of an eating disorder is likely to be higher.

Consult your physician about the resources available to you if you have been diagnosed with an eating disorder.