COMORBIDITY OF DIABETES AND EATING DISORDERS - DOES DIABETES CONTROL REFLECT DISTURBED EATING BEHAVIOR

OBJECTIVE-This multicenter study was designed to explore the prevalenc e of clinical and subclinical eating disorders (EDs), the extent of in tentional omission of insulin and oral antidiabetic agents, and its re lationship to glycemic control in an inpatient and outpatient populati on of men and women with type 1 and type 2 diabetes. RESEARCH DESIGN A ND METHODS-Data have been collected from 12 diabetes medical centers i n two German cities. In a questionnaire and interview-based study, a s ample of male and female patients (n = 341 type 1, n = 322 type 2) was assessed for the following eating disorders: anorexia nervosa, bulimi a nervosa, binge eating disorder, and eating disorder not otherwise sp ecified. For lack of interview data of several patients meeting the sc reening criteria, prevalence ranges were calculated. RESULTS-The overa ll prevalence range of current EDs was 5.9-8.0% (lifetime prevalence 1 0.3-14.0%). When patients were stratified according to type 1 and type 2 diabetes, there was no difference in prevalence of EDs. However, th e distribution of the EDs was different in both types of diabetes, wit h a predominance of binge eating disorder in the type 2 diabetes sampl e. Type 1 (5.9%) and type 2 (2.2%) diabetic patients reported delibera te omission of hyperglycemic drugs (insulin or oral agents) in order t o lose weight. Compared with control subjects, neither the presence of EDs nor insulin omission influenced diabetic control. CONCLUSIONS-The re seems to be no difference in prevalence rates of EDs in both types of diabetes; however, distribution of EDs is different. The findings s uggest that neither EDs nor insulin omission are necessarily associate d with poor control of glycemia. Binge eating disorder seems to preced e type 2 diabetes in most patients and could be one of the causes of o besity that often precedes type 2 diabetes.