The dangerous coexistence of type 1 diabetes and eating disorders: a call for action 

Why is this research important? 
In addition to the health complications that occur with eating disorders and the complications that occur in diabetes, people experiencing both conditions face serious health consequences. Eating disorders are more common in people with type 1 diabetes, when compared to their peers without type 1 diabetes (1, 2). While anyone living with diabetes can be at risk of developing an eating disorder, adolescent and adult females are most at risk. Eating disorders are twice as likely to occur in adolescent girls with type 1 diabetes than in those without (3). An increased risk also applies to disordered eating, with approximately 28% of adolescent girls and 9% of adolescent boys with type 1 diabetes experiencing disordered eating (4). 
In this article by Dalle Grave, he discusses the interaction between eating disorders and type 1 diabetes. He notes that the two primary mechanisms between the two conditions involve people misusing their insulin in order to control weight, and/or the insulin-induced hunger resulting in people finding it difficult to control food intake and consequently results in an increased preoccupation with eating, shape, and weight. Acute diabetic complications can then occur, including DKA, a dangerous and acute complication of diabetes that occurs when the body has reduced insulin (5). 
It is crucial that clinicians are screening for eating disorder behaviours in those people with type 1 diabetes and that evidence-based treatment is delivered quickly. This will help to prevent long term complications of type 1 diabetes, as well as reducing the risk of long-term health and psychosocial effects of the eating disorder. Collaborative multidisciplinary care is also essential, with treatment teams knowledgeable across both conditions and working closely to provide best care for the person across the diabetes and eating disorder. 
Authors: Riccardo Dalle Grave 
Eating disorders are more common among adolescents with type 1 diabetes than in the general peer-group population. This coexistence is often associated with poor glycaemic control and an increased risk of developing severe medical complications. In turn, type 1 diabetes may contribute to the maintenance of eating-disorder psychopathology, and in some cases hinder its treatment. Unfortunately, eating disorders are often not detected by health professionals involved in the management of type 1 diabetes, with negative repercussions on the outcomes of the respective conditions. The increase in the incidence of eating disorders among adolescents during the COVID-19 pandemic, likely also in people with type 1 diabetes, highlights the need to allocate resources for training health professionals involved in the management of type 1 diabetes to detect the early signs of eating disorders with the help of new, specific screening tools. It is also necessary to improve the rapid referral of patients to clinical services that implement the evidence-based treatments recommended for eating disorders, which must work in close contact with the diabetes team. Finally, future research should focus on better identifying the factors that increase the risk of eating disorders in people with type 1 diabetes to prevent the onset of this dangerous, and often undetected, comorbidity. 

Access: Open 

Dalle Grave, R., (2022) The dangerous coexistence of type 1 diabetes and eating disorders: a call for action. Italian Journal of Eating Disorders and Obesity. 11-23. doi: 10.32044/ijedo.2022.03. 
1. Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, et al. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta‐ analysis. Diabetic medicine. 2013;30(2):189-98.  
2. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G. Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ. 2000;320(7249):1563-6. 
3. Gagnon C, Aimé A, Bélanger C. Predictors of comorbid eating disorders and diabetes in people with type 1 and type 2 diabetes. Canadian journal of diabetes. 2017;41(1):52-7.  
4. Wisting L, Frøisland DH, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Disturbed eating behavior and omission of insulin in adolescents receiving intensified insulin treatment: a nationwide population-based study. Diabetes care. 2013;36(11):3382-7.  
5. Philpot U. Eating disorders in young people with diabetes: Development, diagnosis and management. Journal of Diabetes Nursing. 2013;17(6). 

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