DISORDERED EATING BEHAVIOR AND MICROVASCULAR COMPLICATIONS IN YOUNG-WOMEN WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Background insulin-dependent diabetes mellitus (IDDM) and eating disor ders are relatively common among young women in North America. Their c oexistence could lead to poor metabolic control and an increased risk of the microvascular complications of IDDM. Methods We studied 91 youn g women with IDDM at base line and four to five years later to determi ne the prevalence and persistence of disordered eating behavior (on th e basis of self-reported eating and weight-loss practices, including t he intentional omission or underdosing of insulin to control weight) a nd the association of such eating disorders with metabolic control, di abetic retinopathy, and urinary albumin excretion. At base line, the m ean age of the young women was 15+/-2 years and the duration of diabet es was 7+/-4 years. Results At base line, 26 of 97 young women (29 per cent) had highly or moderately disordered eating behavior, which persi sted in 76 (18 percent) and improved in 10 (11 percent). Of the 65 wom en with normal eating behavior at base line (71 percent), 14 (15 perce nt) had disordered eating at follow-up. Omission or underdosing of ins ulin to lose weight was reported by 12 of 88 young women (14 percent) at base line and 30 (34 percent) at follow-up (P=0.003). At base line, the mean (+/-SD) hemoglobin A,, value was higher in the group with hi ghly disordered eating behavior (11.1+/-1.2 percent) than in the group s whose eating behavior was moderately disordered (8.9 +/- 1.7 percent ) or nondisordered (8.7+/-1.6 percent, P<0.001). Disordered eating at base line was associated with retinopathy four years later (P=0.004), when 86 percent of the young women with highly disordered eating behav ior, 43 percent of those with moderately disordered eating behavior, a nd 24 percent of those with nondisordered eating behavior had retinopa thy. Conclusions Disordered eating behavior is common and persistent i n young women with IDDM and is associated with impaired metabolic cont rol and a higher risk of diabetic retinopathy. (C) 1997, Massachusetts Medical Society.