Comorbidity of diabetes mellitus and eating disorders - A follow-up study

Objective: There is increasing evidence that the coexistence of diabetes an d eating disorders (ED) leads to poor glycemic control and an increased ris k of long-term complications. Methods: In a questionnaire- and interview-ba sed study, a sample of 36 out of originally 38 (94.7%) diabetic patients wi th an ED (type-1: n = 13, type-2: n = 23) was assessed after a period of ab out 2 years in order to determine the course of EDs, body mass index (BMI), glycemic control, and psychiatric symptomatology. Results: Five patients ( 13.9%) of the total sample showed full remission for at least 12 consecutiv e weeks. Twenty-two patients (61.6%) showed no change in the diagnosis of t he ED. Four patients (11.1%) shifted from subclinical to clinical EDs and f ive patients (13.9%) vice versa. Of the eight patients who went on to psych otherapy, only one patient (12.5%) showed full remission. Emotional distres s of type-2 diabetics was considerably higher compared to type-1 diabetics, which was rather low at baseline. Except interpersonal distrust as one ED- related variable, no significant change of any psychological variable could be observed in the type-1 diabetic sample during follow-up. Of the 13 type -1 diabetic patients with an ED, five patients deliberately omitted insulin in order to lose weight. These patients showed a more serious psychopathol ogy with regard to each measured psychological variable, a higher BMI, and worse metabolic control compared to those without insulin omission. Type-2 diabetics showed a significant increase in drive for thinness and body diss atisfaction. No considerable change could be observed with regard to BMI, g lycemic control, and depressive and global psychiatric symptomatology in ei ther diabetic subsample during follow-up. Conclusion: EDs tended to persist over time with a considerable shift within the different types of EDs. Ins ulin-purging in type-1 diabetics was associated with enhanced psychopatholo gy, higher BMI, and worse metabolic control. Both mean body mass and ED-rel ated symptoms such as ''drive for thinness'' and ''body dissatisfaction'' i ncreased in the average obese type-2 diabetic sample, illustrating the vici ous circle of low self-esteem, enhanced restraint eating, and binge eating in weight control measures, (C) 2001 Elsevier Science Inc. All rights reser ved.