Eating disorders in type 1 and type 2 diabetes

Abstract

While the risk of developing an eating disorder or subclinical disordered eating behaviors is heightened in both type 1 and type 2 diabetes, these phenomena remain relatively little understood. Eating disorders of all types occur in type 1 diabetes; however the use of insulin restriction for intentional calorie purging is the subject of the most research. Insulin restriction is associated with heightened risk of diabetic ketoacidosis, earlier onset of long-term diabetes complications, and an increased risk of mortality. Binge eating disorder is the more commonly studied eating disorder in type 2 diabetes; however less is known about its medical sequelae. Less research has been done on eating disorders in type 2 diabetes. This chapter provides a comprehensive review of the research on the extent of these problems and what is known about their medical consequences. It describes well-known risk factors common to classic eating disorders and those that occur in diabetes and proposes additional risk factors unique to both forms of diabetes. Screening tools for disordered eating in type 1 diabetes are described and recommended for use in research and general clinical practice. Finally, while there is a dearth of treatment research in this area, suggestions for treatment approaches are made based on both the research and clinical experience.