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Iceta S, Sohier L, Bégin C, Brazeau AS, Rabasa-Lhoret R, Gagnon C. Impact of glycemic variability on cognitive impairment, disordered eating behaviors and self-management skills in patients with type 1 diabetes: study protocol for a cross-sectional online study, the Sugar Swing study. BMC Endocr Disord 2022; 22:283. [PMID: 36401237 PMCID: PMC9673316 DOI: 10.1186/s12902-022-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People living with type 1 diabetes (PWT1D) are at increased risk for impairments in brain function, which may impact on daily life. Cognitive impairments in PWT1D might contribute to increasing eating disorders, reducing self-management skills, and deteriorating glycemic control. Glycemic variability may be a key determinant of disordered eating behaviors, as well as of cognitive impairments. The main objective of this study is to better understand the impact of glycemic variability in disordered eating behaviors and cognitive impairment, and its consequences on self-management skills in PWT1D. METHOD We aim to recruit 150 PWT1D with 50% of men and women in this cross-sectional study. Participants will record their glycemic variability over a 10-day period using a continuous glucose monitoring system (CGMS) and track their dietary intakes using image-assisted food tracking mobile application (2 days). Over four online visits, eating behaviors, diabetes self-management's skills, anxiety disorders, depression disorder, diabetes literacy and numeracy skills, cognitive flexibility, attention deficit, level of interoception, and impulsivity behaviors will be assessed using self-reported questionnaires. Cognitive functions (i.e., attention, executive functions, impulsivity, inhibition and temporal discounting), will be measured. Finally, medical, biological and sociodemographic data will be collected. To further our understanding of the PWT1D experience and factors impacting glycemic self-management, 50 PWT1D will also participate in the qualitative phase of the protocol which consist of individual in-depth face-to-face (virtual) interviews, led by a trained investigator using a semi-structured interview. DISCUSSION This study will contribute to highlighting the consequences of blood sugar fluctuations (i.e., "sugar swings"), in daily life, especially how they disrupt eating behaviors and brain functioning. A better understanding of the mechanisms involved could eventually allow for early detection and management of these problems. Our study will also seek to understand the patients' point of view, which will allow the design of appropriate and meaningful recommendations. TRIAL REGISTRATION ClinicalTrials.gov, NCT05487534. Registered 4 August 2022.
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Affiliation(s)
- Sylvain Iceta
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.
- Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada.
| | - Léonie Sohier
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada
- School of Psychology, Laval University, Québec, QC, Canada
| | - Catherine Bégin
- School of Psychology, Laval University, Québec, QC, Canada
- Centre d'expertise, Poids, Image Et Alimentation (CEPIA), Québec, QC, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Montreal, QC, Canada
- Montreal Institute for Clinical Research, Montreal, QC, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Institute for Clinical Research, Montreal, QC, Canada
- Department of Nutrition, Montreal University, Montreal, QC, Canada
| | - Claudia Gagnon
- CHU de Québec-Université Laval Research Centre, Québec, QC, Canada
- Department of Medicine, Laval University, Québec, QC, Canada
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Trott M, Driscoll R, Iraldo E, Pardhan S. Pathological eating behaviours and risk of retinopathy in diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord 2022; 21:1047-1054. [PMID: 35673454 PMCID: PMC9167365 DOI: 10.1007/s40200-022-00980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/13/2022] [Indexed: 01/23/2023]
Abstract
Background Diabetes mellitus can cause several long-term macrovascular and microvascular complications including nephropathy, neuropathy, and retinopathy (DR). Several studies have reported positive associations between eating pathologies and DR; however, these studies have not been aggregated and sub-grouped into type of pathological eating behaviour, and the differences in risk according to type of eating behaviour is unknown. The aim of this review, therefore, was to aggregate risks of DR in populations with and without pathological eating behaviours, stratified according to eating behaviour. Methods A systematic review and meta-analysis was conducted. Major databases and grey literature were search from inception until 1/6/2021. Studies reporting the prevalence of pathological eating behaviours (against a control group with no pathological eating behaviours) in diabetic people with and without DR were included. Odds ratios were calculated from primary data. Results Seven studies with eight independent outcomes with a total of 1162 participants were included. The odds ratio of DR in the total pooled analysis was 2.94 (95%CI 1.86-4.64; p = <0.001; I2 = 29.59). Two types of eating behaviour yielded enough data for sub-group analysis. Eating disorder not otherwise specified yielded an odds ratio of 2.73 (95%CI 1.81-4.10; p = <0.001; I2 = 0.00), and binge eating disorder yielded an non-significant odds ratio of 0.92 (95%CI 0.31-2.77; p = 0.887;I2 = 0.00). Discussion The likelihood of DR increases almost three times in the presence of pathological eating behaviours. More studies are required to confirm this in clinical populations stratified by eating disorder. Practitioners working with people with diabetes should closely monitor eating behaviours to preclude this risk. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-00980-x.
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Affiliation(s)
- Mike Trott
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
| | - R. Driscoll
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
| | - E. Iraldo
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
| | - S. Pardhan
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
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Abstract
Binge eating disorder (BED) is the most common eating disorder and an important public health problem. Lifetime prevalence of BED in the United States is 2.6%. In contrast to other eating disorders, the female to male ratio in BED is more balanced. BED co-occurs with a plethora of psychiatric disorders, most commonly mood and anxiety disorders. BED is also associated with obesity and its numerous complications. Although BED is similar in men and women in presentation and treatment outcomes, there are some key neurobiological differences that should be taken in consideration when personalizing treatment.
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Affiliation(s)
- Anna I Guerdjikova
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA.
| | - Nicole Mori
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA
| | - Leah S Casuto
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA
| | - Susan L McElroy
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA
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Moskovich AA, Dmitrieva NO, Babyak MA, Smith PJ, Honeycutt LK, Mooney J, Merwin RM. Real-time predictors and consequences of binge eating among adults with type 1 diabetes. J Eat Disord 2019; 7:7. [PMID: 30923613 PMCID: PMC6421642 DOI: 10.1186/s40337-019-0237-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/20/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Objective binge eating (OBE) is common among individuals with type 1 diabetes (T1D) and may have negative consequences for glycemic control. Recent studies have suggested that diabetes distress (i.e., emotional distress specific to diabetes and living with the burden of management) is a distinct emotional experience among individuals with diabetes. Preliminary studies have found diabetes distress is associated with eating disorder symptoms and poor glycemic control. The aim of the current study was to examine real-time emotional precursors and consequences of OBE in adults with T1D (i.e., general negative affect, specific emotional states and diabetes distress) using ecological momentary assessment methods. We also explore the impact of OBE on 2-h postprandial glycemic control relative to non-OBE eating episodes. METHODS Adults with T1D (N = 83) completed 3-days of ecological momentary assessment assessing mood and eating behavior using a telephone-based survey system. Participants were prompted to rate momentary affect, including level diabetes distress, at random intervals and reported on eating episodes. Participants also wore continuous glucose monitors allowing for ongoing assessment of glycemic control. Multi-level modeling was used to examine between- and within-person effects of momentary increases in emotions prior to eating on the likelihood of OBE and the impact of OBE on postprandial blood glucose. Generalized linear mixed models examined whether change in post-meal affect differed between OBE and non-OBE episodes. RESULTS Participants were predominately middle-aged (Mean = 42; SD = 12.43) Caucasian (87%) females (88%) reporting clinically significant eating disorder symptoms (76%). Nearly half of the sample (43%) reported OBE during the 3-day study period. The between-person effect for negative affect was significant (OR = 1.93, p < .05), indicating a 93% increased risk of OBE among individuals with higher negative affect compared to individuals with average negative affect. Between-person effects were also significant for guilt, frustration and diabetes distress (OR = 1.48-1.77, ps < .05). Analyses indicated that mean change in post-meal negative affect was significantly greater for OBE relative to non-OBE episodes (B = 0.44, p < .001). Blood glucose at 120 min postprandial was also higher for OBE than for non-OBE episodes (p = .03). CONCLUSIONS Findings indicate that individuals who tend to experience negative affect and diabetes distress before eating are at increased risk of OBE at the upcoming meal. Results also suggest that engaging in binge eating may result in greater subsequent negative affect, including diabetes distress, and lead to elevated postprandial blood glucose levels. These findings add to a growing literature suggesting diabetes distress is related to eating disordered behaviors among individuals with T1D.
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Affiliation(s)
| | | | - Michael A Babyak
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Patrick J Smith
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Lisa K Honeycutt
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Jan Mooney
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Rhonda M Merwin
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
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5
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De Paoli T, Rogers PJ. Disordered eating and insulin restriction in type 1 diabetes: A systematic review and testable model. Eat Disord 2018; 26:343-360. [PMID: 29182474 DOI: 10.1080/10640266.2017.1405651] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To provide an overview of the existing literature pertaining to insulin restriction as a disordered eating behaviour in individuals with type 1 diabetes and present a novel maintenance model: The Transdiagnostic Model of Disordered Eating in Type 1 Diabetes. METHOD A systematic review was conducted of the current literature relevant to insulin restriction and/or omission in the context of disordered eating in type 1 diabetes. A new maintenance model was then developed by incorporating diabetes-specific factors into existing eating disorder models. RESULTS Type 1 diabetes may complicate the development and maintenance of disordered eating behaviour. Diabetes-specific circumstances, including disease diagnosis, insulin management, insulin restriction, and diabetes-related complications, contribute to the maintenance of disordered eating cognitions and behaviours. DISCUSSION The proposed model offers a comprehensive representation of insulin restriction as a disordered eating behaviour in type 1 diabetes. Future research should test the model to further understand the mechanisms underlying disordered eating in type 1 diabetes and inform treatments for this at-risk population.
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Affiliation(s)
- Tara De Paoli
- a Melbourne School of Psychological Sciences , The University of Melbourne , Melbourne , VIC , Australia
| | - Peter J Rogers
- b Nutrition and Behaviour Unit, School of Experimental Psychology , University of Bristol , Bristol , United Kingdom
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Conviser JH, Fisher SD, McColley SA. Are children with chronic illnesses requiring dietary therapy at risk for disordered eating or eating disorders? A systematic review. Int J Eat Disord 2018; 51:187-213. [PMID: 29469935 DOI: 10.1002/eat.22831] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pediatric chronic illnesses (CI) can affect a child's mental health. Chronic illnesses with treatment regimens that specify a therapeutic diet may place the child at increased risk for disordered eating and specific eating disorders (ED). The aim of this review is to examine the relation between diet-treated CI and disordered eating and to determine the order of onset to infer directionality. Diet-treated CI is hypothesized to precede and to be associated with disordered eating. METHOD A comprehensive search of empirical articles that examine the relation between diet-treated CI (diabetes, cystic fibrosis, celiac disease, gastrointestinal disorders, and inflammatory bowel diseases) and disordered eating was conducted in Medline and PsycINFO using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A table of the sample's characteristics, ED measures, major pertinent findings, and the onset of CI in relation to ED were provided. RESULTS Diet-treated CI was associated with disordered eating and ED. Diet-treated CI had onset prior to disordered eating in most studies, except for inflammatory bowel diseases. Disordered eating and unhealthy weight management practices put children at risk for poor medical outcomes. DISCUSSION Interventions for diet-treated CI require a focus on diet and weight, but may increase the risk for disordered eating. Future research is needed to elucidate the mechanisms that transform standard treatment practices into pathological eating, including characteristics and behaviors of the child, parents/care providers, family, and treatment providers.
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Affiliation(s)
- Jenny H Conviser
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario St, Chicago, Illinois, 60611
| | - Sheehan D Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario St, Chicago, Illinois, 60611
| | - Susanna A McColley
- Department of Pediatrics, Division of Pulmonary Medicine, Northwestern University Feinberg School of Medicine, 420 E. Superior Street, Chicago, Illinois, 60611
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Abstract
Binge eating disorder (BED) is the most common eating disorder and an important public health problem. Lifetime prevalence of BED in the United States is 2.6%. In contrast to other eating disorders, the female to male ratio in BED is more balanced. BED co-occurs with a plethora of psychiatric disorders, most commonly mood and anxiety disorders. BED is also associated with obesity and its numerous complications. Although BED is similar in men and women in presentation and treatment outcomes, there are some key neurobiological differences that should be taken in consideration when personalizing treatment.
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Affiliation(s)
- Anna I Guerdjikova
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA.
| | - Nicole Mori
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA
| | - Leah S Casuto
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA
| | - Susan L McElroy
- Lindner Center of HOPE, 4075 Old Western Row Road, Mason, OH 45040, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 4075 Old Western Row Road, Mason, OH 45040, USA
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8
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Abstract
PURPOSE To gain further understanding of the general medical comorbidity of binge eating disorder (BED) beyond its association with obesity. METHOD We reviewed studies of general medical comorbidity in people with BED or clinically significant binge eating behavior beyond obesity. We also reviewed studies of BED in specific medical conditions. RESULTS Three broad study categories of medical comorbidity in BED were found: cross-sectional studies of medical conditions in BED; prospective studies of medical conditions in BED; and studies of BED in specific medical conditions. Cross-sectional epidemiologic data suggest that BED is associated with medical conditions related to obesity, including diabetes, hypertension, dyslipidemias, sleep problems/disorders, and pain conditions, and that BED may be related to these conditions independent of obesity and co-occurring psychiatric disorders. Prospective data suggest that BED may be associated with type 2 diabetes and metabolic syndrome. BED or binge eating behavior is also associated with asthma and gastrointestinal symptoms and disorders, and among women, menstrual dysfunction, pregnancy complications, intracranial hypertension, and polycystic ovary syndrome. CONCLUSIONS BED is associated with substantial medical comorbidity beyond obesity. Further study of the general medical comorbidity of BED and its relationship to obesity and co-occurring psychiatric disorders is greatly needed.
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Piłaciński S, Zozulińska-Ziółkiewicz DA. Influence of lifestyle on the course of type 1 diabetes mellitus. Arch Med Sci 2014; 10:124-34. [PMID: 24701225 PMCID: PMC3953982 DOI: 10.5114/aoms.2014.40739] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/12/2013] [Accepted: 06/02/2013] [Indexed: 12/15/2022] Open
Abstract
Type 1 diabetes (T1DM) is an autoimmune disease that requires insulin treatment from the time of diagnosis. Its clinical course depends on both genetic and environmental factors, and the lifestyle of a patient modulates their interaction. The evidence about the influence of lifestyle on the course of T1DM is increasing. In this paper, we present evidence on the relationship between lifestyle parameters and diabetes-related outcomes. We discuss the most commonly addressed factors associated with lifestyle, such as physical activity, nutrition and smoking, and those with sparse evidence in T1DM, such as socioeconomic status, sleep duration, psychological stress and illicit drugs intake.
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Affiliation(s)
- Stanisław Piłaciński
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
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Abstract
Disordered eating behaviors are common in the adolescent population. These behaviors are especially dangerous for young females with type 1 diabetes due to frequent alterations in insulin levels. This article provides an overview of disordered eating in adolescent females with type 1 diabetes, including prevalence and morbidity, insulin omission and associated health outcomes, risk factors, and suggestions for screening and prevention.
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Affiliation(s)
- Terri L Schmitt
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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12
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Gagnon C, Aimé A, Bélanger C, Markowitz JT. Comorbid Diabetes and Eating Disorders in Adult Patients. DIABETES EDUCATOR 2012; 38:537-42. [DOI: 10.1177/0145721712446203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Purpose The lack of research concerning treatment for individuals with diabetes mellitus (DM) and comorbid eating disorders (ED) contributes to the gulf between the psychosocial needs of individuals with the two conditions and the treatment they receive. Empirical evidence has established that the prognosis of patients with this comorbid diagnosis (ED-DM) is poor in the absence of a specialized DM treatment specifically adapted to ED. In individuals with DM, comorbid ED is associated with numerous complications. Despite these interactions, current knowledge about the comorbid diagnosis is limited, and eating disorders in patients with diabetes often remain undiagnosed. This article presents standard procedures for assessment and optimal therapeutic interventions for patients with ED and DM. Conclusion In patients with diabetes, problematic eating behaviors and symptoms should be assessed routinely. When an eating disorder is detected, diabetes management needs to be adapted, binge eating or medication misuse needs to be addressed, and eating disorder specialists should be included in the multidisciplinary team.
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Affiliation(s)
- Cynthia Gagnon
- University of Quebec in Montreal, Department of Psychology, Montreal, Quebec (Gagnon, doctoral student in psychology)
- University of Quebec in Outaouais, Department of Psychoeducation and Psychology, St-Jerome, Quebec (Dr Aimé)
- University of Quebec in Montreal and Douglas Mental Health Institute and McGill University, Department of Psychology, Montreal, Quebec (Dr Bélanger)
- Joslin Diabetes Center, Section of Genetics and Epidemiology, Boston, Massachusetts (Dr Markowitz)
| | - Annie Aimé
- University of Quebec in Montreal, Department of Psychology, Montreal, Quebec (Gagnon, doctoral student in psychology)
- University of Quebec in Outaouais, Department of Psychoeducation and Psychology, St-Jerome, Quebec (Dr Aimé)
- University of Quebec in Montreal and Douglas Mental Health Institute and McGill University, Department of Psychology, Montreal, Quebec (Dr Bélanger)
- Joslin Diabetes Center, Section of Genetics and Epidemiology, Boston, Massachusetts (Dr Markowitz)
| | - Claude Bélanger
- University of Quebec in Montreal, Department of Psychology, Montreal, Quebec (Gagnon, doctoral student in psychology)
- University of Quebec in Outaouais, Department of Psychoeducation and Psychology, St-Jerome, Quebec (Dr Aimé)
- University of Quebec in Montreal and Douglas Mental Health Institute and McGill University, Department of Psychology, Montreal, Quebec (Dr Bélanger)
- Joslin Diabetes Center, Section of Genetics and Epidemiology, Boston, Massachusetts (Dr Markowitz)
| | - Jessica Tuttman Markowitz
- University of Quebec in Montreal, Department of Psychology, Montreal, Quebec (Gagnon, doctoral student in psychology)
- University of Quebec in Outaouais, Department of Psychoeducation and Psychology, St-Jerome, Quebec (Dr Aimé)
- University of Quebec in Montreal and Douglas Mental Health Institute and McGill University, Department of Psychology, Montreal, Quebec (Dr Bélanger)
- Joslin Diabetes Center, Section of Genetics and Epidemiology, Boston, Massachusetts (Dr Markowitz)
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Takii M, Uchigata Y, Kishimoto J, Morita C, Hata T, Nozaki T, Kawai K, Iwamoto Y, Sudo N, Kubo C. The relationship between the age of onset of type 1 diabetes and the subsequent development of a severe eating disorder by female patients. Pediatr Diabetes 2011; 12:396-401. [PMID: 20723101 DOI: 10.1111/j.1399-5448.2010.00708.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To determine the age of onset of type 1 diabetes that is most closely related to the subsequent development of a severe eating disorder such as anorexia nervosa (AN) or bulimia nervosa (BN). METHODS Participants were 53 female type 1 diabetes patients with AN or BN referred to our outpatient clinic from the Diabetes Center of Tokyo Women's Medical University. Forty-nine female type 1 diabetes patients who regularly visited the Diabetes Center and had no eating disorder-related problems constituted the 'direct control' group, whereas 941 female patients who for the first time visited the Diabetes Center constituted the 'historical control' group. The kernel function method was used to generate a density estimation of the onset age of each group and the chi-square test was used to compare the distribution. RESULTS The control groups had similar density shapes for the onset age of type 1 diabetes, but both differed from the 'eating disorder' group. For onset age 7-18 yr, the density of the 'eating disorder' group was higher than those of the control groups, but for the younger and older onset ages the densities were lower. The 'eating disorder' group developed type 1 diabetes significantly more frequently than the 'historical control' group between 7 and 18 yr of age (χ2 = 9.066, p < 0.011). CONCLUSION The development of type 1 diabetes in preadolescence or adolescence seems to place girls at risk for the subsequent development of AN or BN. Careful attention should be paid to these high-risk patients.
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Affiliation(s)
- Masato Takii
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Starkey K, Wade T. Disordered eating in girls with Type 1 diabetes: Examining directions for prevention. CLIN PSYCHOL-UK 2010. [DOI: 10.1080/13284201003660101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Karina Starkey
- School of Psychology, Flinders University , Adelaide, South Australia, Australia
| | - Tracey Wade
- School of Psychology, Flinders University , Adelaide, South Australia, Australia
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Kichler JC, Foster C, Opipari-Arrigan L. The Relationship between Negative Communication and Body Image Dissatisfaction in Adolescent Females with Type 1 Diabetes Mellitus. J Health Psychol 2008; 13:336-47. [DOI: 10.1177/1359105307088138] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Maladaptive eating attitudes and behaviors are common in adolescent females with Type 1 Diabetes Mellitus (T1DM). This research assessed potential pathways through which individual and familial factors relate to treatment adherence and glycemic control. Seventy-five females with T1DM (aged 11—17 years) and their mothers completed questionnaires regarding communication, diabetes management, and eating attitudes and behaviors. Hierarchical regression analyses found that body image dissatisfaction moderates the relationship between negative communication and maladaptive eating attitudes and behaviors. Treatment adherence mediates the relationship between maladaptive eating attitudes and behaviors and glycemic control. None of the participants endorsed omitting insulin for the purposes of weight management. This study highlights the need to address familial and individual factors along with treatment adherence within this population.
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Affiliation(s)
- Jessica C. Kichler
- University of Michigan Health System & C. S. Mott Children's Hospital, USA,
| | - Carol Foster
- University of Michigan Health System & C. S. Mott Children's Hospital, USA
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Takii M, Uchigata Y, Tokunaga S, Amemiya N, Kinukawa N, Nozaki T, Iwamoto Y, Kubo C. The duration of severe insulin omission is the factor most closely associated with the microvascular complications of Type 1 diabetic females with clinical eating disorders. Int J Eat Disord 2008; 41:259-64. [PMID: 18095311 DOI: 10.1002/eat.20498] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate which features of eating disorders are associated with retinopathy and nephropathy in Type 1 diabetic females with clinical eating disorders. METHOD Participants were 109 Type 1 diabetic females with clinical eating disorders diagnosed by the structured clinical interview for DSM-IV (bulimia nervosa [n = 70], binge-eating disorder [n = 28], anorexia nervosa [n = 7], and eating disorder not otherwise specified [n = 4]). Retinopathy and nephropathy were screened and demographic, medical, and eating disorder related factors were investigated. To identify the factors associated with each complication, logistic regression analysis was done. RESULTS Duration of severe insulin omission and duration of Type 1 diabetes were significantly associated with retinopathy (odds ratios = 1.35 and 1.23, respectively) and nephropathy (odds ratio = 1.35 and 1.21, respectively) in multivariate regression analyses. CONCLUSION Of the various problematic behavioral factors related to eating disorders, the duration of severe insulin omission was the factor most closely associated with the retinopathy and nephropathy of Type 1 diabetic females with clinical eating disorders by multivariate analysis. This finding may help patients who deliberately omit insulin become aware of medical risk of insulin omission.
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Affiliation(s)
- Masato Takii
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Smith FM, Latchford GJ, Hall RM, Dickson RA. Do chronic medical conditions increase the risk of eating disorder? A cross-sectional investigation of eating pathology in adolescent females with scoliosis and diabetes. J Adolesc Health 2008; 42:58-63. [PMID: 18155031 DOI: 10.1016/j.jadohealth.2007.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 06/25/2007] [Accepted: 07/17/2007] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate levels of eating pathology in female adolescents diagnosed with a chronic condition causing appearance change (adolescent-onset idiopathic scoliosis), a chronic condition affecting nutritional behavior (insulin-dependent diabetes mellitus), and healthy age-matched controls. METHOD Cross-sectional comparison of 192 females aged 11-19 years; 76 individuals diagnosed with scoliosis, 40 diagnosed with diabetes, and 76 control participants. Disordered eating behavior was quantified using the Eating Disorder Examination Questionnaire, and weight and body mass index (weight [kg]/height [m(2)]) measurements were taken for each participant. RESULTS The scoliosis group weighed less and had lower BMI scores (p < .001) than control participants. Of the participants with scoliosis, 25% were severely underweight, but only two met the behavioral criteria for anorexia nervosa; in others no association with disordered eating behaviour was found. Eating disorders were significantly more common (p < .05) in the diabetes participants than in the control group, with 27.5% of the group classified as having bulimia or binge eating disorder. All those classified as overweight or obese in the diabetes group were classified as pathological in terms of eating behavior. CONCLUSIONS The relationship between scoliosis and low body mass is a concern but is not a result of an eating disorder. Etiological mechanisms remain unclear and require further investigation. In the diabetes participants, bulimia and binge eating may prejudice effective condition management. Implications for successful adaptation, treatment intervention, and future research are discussed.
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Affiliation(s)
- Fiona M Smith
- Academic Unit of Psychiatry and Behavioral Sciences, University of Leeds, Leeds, United Kingdom
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Papelbaum M, Appolinário JC, Moreira RDO, Duchesne M, Kupfer R, Coutinho WF. Distribuição de transtornos alimentares em indivíduos com diabetes melito do tipo 1 e do tipo 2: descrição de dois casos. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-81082007000100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A presença de alterações do comportamento alimentar parece estar aumentada no diabetes melito (DM). Entretanto, a distribuição das diversas categorias de transtornos alimentares tende a se distinguir de acordo com a fisiopatologia do diabetes. O objetivo dessa apresentação é discutir dois casos distintos de ocorrência de transtornos alimentares no DM do tipo 1 (DM1) e no DM do tipo 2 (DM2). A paciente A é do sexo feminino, tem 19 anos e apresenta DM1 desde os 13 anos. Evidenciava sintomas depressivos proeminentes e, há 2 anos, passou a apresentar episódios de compulsão alimentar seguidos de vômitos auto-induzidos e omissão das doses de insulina com o objetivo de evitar ganho de peso. Em função desse comportamento, apresentou diversas internações associadas a uma piora do controle glicêmico. Após o uso de fluoxetina, houve remissão da psicopatologia alimentar e melhora do controle do DM. A paciente B possui 42 anos e é portadora do DM2 há 6 anos. Apresenta obesidade grau II e vinha exibindo, antes mesmo do diagnóstico do DM2, episódios de compulsão alimentar na ausência de comportamentos compensatórios, que prejudicavam o controle metabólico do diabetes. Foi iniciada fluoxetina até a dose de 60 mg/dia, com remissão do descontrole alimentar, perda ponderal e redução da hemoglobina glicosilada. A incidência de transtornos alimentares no DM1 estaria associada com um aumento da preocupação com a forma corporal e a possibilidade da omissão do uso da insulina como comportamento compensatório. No DM2, a obesidade seria um dos fatores associados ao desenvolvimento da psicopatologia alimentar.
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Affiliation(s)
- Marcelo Papelbaum
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | - José Carlos Appolinário
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | | | - Mônica Duchesne
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | - Rosane Kupfer
- Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro
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Wagner J, James A. A pilot study of school counselor's preparedness to serve students with diabetes: relationship to self-reported diabetes training. THE JOURNAL OF SCHOOL HEALTH 2006; 76:387-92. [PMID: 16918873 DOI: 10.1111/j.1746-1561.2006.00130.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This cross-sectional, observational pilot study investigated the knowledge, attitudes, and awareness of 132 school counselors regarding students with diabetes. Respondents were primarily white, female, with a master's degree, aged 42 years, and with 10 years of school counseling experience. Most counselors worked at large, public, suburban, and high schools. A majority reported that there were children with diabetes in their schools, and 40% had worked directly with several students with diabetes. However, most indicated that they had received no specific training about diabetes. On a standardized measure of school personnel knowledge of diabetes, school counselors showed only a basic level of practical diabetes knowledge that is insufficient to provide effective support for diabetic students. Relative to counselors who reported no diabetes training, those who reported diabetes training showed more knowledge of diabetes and its management in schoolchildren. On a standardized measure of the psychosocial impact of diabetes, those who reported training also endorsed attitudes that indicated better appreciation of the psychosocial impact of living with diabetes. Educational attainment and number of students with diabetes served in the past was not related to knowledge or attitudes. Awareness of recommended accommodations, educational planning, problems with school personnel, and risk for psychological disturbance among diabetic students was limited. These findings suggest that school counselors are not well prepared to support diabetic students and that training may help prepare them. Practical suggestions for school counselors' care of diabetic students are offered.
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Affiliation(s)
- Julie Wagner
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Abstract
The aim of this comparative study was to determine the prevalence of disordered eating behaviors (DEBs) and its affecting factors among adolescents with Type 1 diabetes. Subjects were 45 diabetic adolescents and 55 nondiabetic healthy control subjects. The main outcome measures used were the Eating Attitudes Test and the Body Image Scale (BIS). Findings suggest that DEBs are almost four times as common in diabetic adolescents as in their nondiabetic peers (p < .001). Strict diet restriction and insulin misuse (p < .01) were related to DEBs. Disordered eating behaviors make a significant contribution to menstrual problems (p < .001) and poor metabolic control (p < .001). There was a nonsignificant negative correlation between DEBs and the BIS score. Health care professionals should be aware of the potential effect of subclinical and clinical DEBs including insulin misuse and strict diet in weight-conscious people with Type 1 diabetes who have poor metabolic control and menstrual problems.
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Affiliation(s)
- Rukiye Pinar
- College of Nursing, Marmara University, Istanbul, Turkey.
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Grylli V, Wagner G, Hafferl-Gattermayer A, Schober E, Karwautz A. Disturbed eating attitudes, coping styles, and subjective quality of life in adolescents with Type 1 diabetes. J Psychosom Res 2005; 59:65-72. [PMID: 16186000 DOI: 10.1016/j.jpsychores.2005.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Revised: 02/02/2005] [Accepted: 02/02/2005] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate coping styles and quality of life in youth with Type 1 diabetes with and without eating disorders and to identify relationships between these variables in each group. METHODS Adolescents were evaluated for eating disorders with a two-stage diagnostic procedure. Adolescents with and without eating disorders then provided data on coping styles and on subjective well-being. RESULTS Adolescents with Type 1 diabetes and disordered eating behavior reported more often blaming themselves and resorting to wishful thinking and poorer physical and psychosocial quality of life than do adolescents with Type 1 diabetes without disordered eating behavior. Specific coping strategies were also positively linked with quality of life and metabolic control. CONCLUSIONS Eating disorders and disordered eating behavior in adolescents with Type 1 diabetes seem to be associated with certain negative and avoidant coping strategies and with impeded physical and bio-psychosocial well-being.
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Affiliation(s)
- Vasileia Grylli
- Eating Disorders Unit, University Clinic of Neuropsychiatry of Childhood and Adolescence, General Hospital of Vienna, Medical University Vienna, Austria
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Grylli V, Hafferl-Gattermayer A, Schober E, Karwautz A. Prevalence and clinical manifestations of eating disorders in Austrian adolescents with type-1 diabetes. Wien Klin Wochenschr 2004; 116:230-4. [PMID: 15143861 DOI: 10.1007/bf03041052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To investigate prevalence and clinical manifestations of DSM-IV clinical eating disorders and subsyndromal eating problems among adolescents with type-1 diabetes. METHOD A clinical sample of 251 adolescents with type-1 diabetes was recruited from multiple centres. Of these adolescents, 199 (96 girls and 103 boys--79.3% participation rate) with a mean age of 14.1 years (SD: 2.6) were screened for eating disorders and then underwent DSM-IV-based clinical assessment of eating disorders by interview. RESULTS 11.5% of the girls and none of the boys with type-1 diabetes had DSM-IV eating disorders, whereas 13.5% of the girls and 1% of the boys had subsyndromal problems of eating and shape. Girls with both type-1 diabetes and a clinical or subclinical eating disorder had a significantly higher body-mass index than those without eating problems. CONCLUSION This Austrian study supports cumulative international evidence that among youths with type-1 diabetes, adolescent girls and especially those having a higher body mass are particularly vulnerable for manifesting pathology of eating, weight and shape. Thus, this particular population requires screening of eating behaviour and relevant psychopathology, close monitoring, and psychosocial interventions through cooperative efforts of specialised centres.
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Affiliation(s)
- Vasileia Grylli
- Eating Disorders Unit, University Clinic of Neuropsychiatry of Childhood and Adolescence, Medical University of Vienna, Vienna, Austria
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Kenardy J, Mensch M, Bowen K, Green B, Walton J, Dalton M. Disordered eating behaviours in women with Type 2 diabetes mellitus. Eat Behav 2004; 2:183-92. [PMID: 15001045 DOI: 10.1016/s1471-0153(01)00028-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of the article is to investigate the relationship between disordered eating, particularly binge eating, and Type 2 diabetes in women. Subjects included 215 women with Type 2 diabetes (mean age: 58.9 years, mean body mass index (BMI)=33.5 kg/m(2)). Measurements included a structured clinical interview for disordered eating (Eating Disorder Examination, EDE), self-report measures of psychological functioning, glycosylated haemoglobin A1c, BMI. A total of 20.9% of women was binge eating regularly. Binge eating was associated with poorer well being, earlier age of diagnosis, poorer self-efficacy for diet and exercise self-management, and higher BMI. Binge eating frequency predicted blood glucose control after controlling for BMI and exercise level. A history of binge eating independently predicted age of diagnosis of diabetes. Binge eating is relatively common in women with Type 2 diabetes. The relationship between binge eating severity and diabetic control is not explained by overweight. Binge eating may be an independent risk factor for Type 2 diabetes.
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Affiliation(s)
- J Kenardy
- School of Psychology, University of Queensland, Brisbane, Queensland 4072, Australia.
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Takii M, Uchigata Y, Komaki G, Nozaki T, Kawai H, Iwamoto Y, Kubo C. An integrated inpatient therapy for type 1 diabetic females with bulimia nervosa: a 3-year follow-up study. J Psychosom Res 2003; 55:349-56. [PMID: 14507546 DOI: 10.1016/s0022-3999(02)00629-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe an "integrated inpatient therapy" for type 1 diabetic patients with recurrent binge eating and to assess its effectiveness for females with bulimia nervosa (BN). METHODS At the first visit to our outpatient clinic for treatment of an eating disorder and diabetes, type 1 diabetic females with BN underwent single session "outpatient counseling." All patients then returned to the referring physician for further treatment and observation. None of the BN patients had the minimum expected 1% fall in HbA1c and all were therefore encouraged to undergo our "integrated inpatient therapy." However, only patients accepting inpatient treatment on their own volition were admitted. An "INPATIENT" group (n=9) consisted of those who underwent inpatient therapy and had a 3-year follow-up period after discharge. The clinical course was assessed by the HbA1c and BMI course and by comparison of psychological/behavioral factors between baseline and follow-up. For reference, the clinical course of a "NON-INPATIENT" group (n=10), who did not have the inpatient therapy for at least 2 years after first visit, was also assessed. RESULTS The "INPATIENTs" had significantly lower HbA1c; lower psychological test scores related to eating disorder psychopathology, depressiveness, and anxiety-proneness; a reduced frequency and amount of binge eating; and fewer patients exhibited purging behaviors at follow-up than at first visit. At follow-up, seven (78%) "INPATIENTs" no longer fulfilled any criterion for clinical or subclinical eating disorders. The "NON-INPATIENTs" had no significant improvement. CONCLUSION The findings give interesting insights into the possibilities of "integrated inpatient therapy" as an effective treatment for type 1 diabetic females with BN.
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Affiliation(s)
- Masato Takii
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Abstract
Diabetes mellitus (DM) presents itself in two forms: insulin-dependent (type 1 DM) and non-insulin-dependent (type 2 DM). Although type 2 DM usually has an adult onset, in recent years there has been a significant rise in the number of children diagnosed with type 2 DM in the United States. Reasons for this increased frequency are believed to be a larger percentage of children who are overweight, a family history of diabetes, and a considerable increase in the use of psychotropic medication in children. The diagnosis of DM is a significant stressor not only for patients but also for their environment. Children with DM are sometimes stigmatized by their peers and relatives who do not understand the illness or are frightened by it. Some children also may need to alter several of their customary routines and are often scared to participate in activities in which they were previously engaged. The family's response to the diagnosis of DM may have a negative effect on glycemic control. Differences have been found in the way patients with type 1 DM and type 2 DM cope with and adapt to their diagnosis.
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Affiliation(s)
- David Szydlo
- Yale Child Study Center, National Center for Children Exposed to Violence, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520, USA.
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Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res 2002; 53:1053-60. [PMID: 12479986 DOI: 10.1016/s0022-3999(02)00417-8] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety is associated with decreased functioning and quality of life. It may have added importance in diabetes for its potential adverse effects on regimen adherence and glycemic control. OBJECTIVE To estimate the prevalence of clinically significant anxiety in adults with diabetes. RESEARCH DESIGN AND METHODS MEDLINE and PsycINFO databases and published reference lists were searched to identify studies that determined the prevalence of anxiety in diabetes from threshold scores on self-report measures or from diagnostic interviews. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. RESULTS Eighteen studies having a combined population (N) of 4076 (2584 diabetic subjects, 1492 controls) satisfied the inclusion criteria. Most did not adjust for the effects of moderator variables such as gender, and only one was community-based. Generalized anxiety disorder (GAD) was present in 14% of patients with diabetes. The subsyndromal presentation of anxiety disorder not otherwise specified and of elevated anxiety symptoms were found in 27% and 40%, respectively, of patients with diabetes. The prevalence of elevated symptoms was significantly higher in women compared to men (55.3% vs. 32.9%, P<.0001) and similar in patients with Type 1 vs. Type 2 diabetes (41.3% vs. 42.2%, P=.80). CONCLUSION GAD is present in 14% and elevated symptoms of anxiety in 40% of patients with diabetes who participate in clinical studies. Additional epidemiological studies are needed to determine the prevalence of anxiety in the broader population of persons with diabetes.
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Affiliation(s)
- Allison B Grigsby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
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Azevedo APD, Papelbaum M, D'Elia F. Diabetes e transtornos alimentares: uma associação de alto risco. BRAZILIAN JOURNAL OF PSYCHIATRY 2002. [DOI: 10.1590/s1516-44462002000700017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O diabetes mellitus (DM) é uma doença crônica que cursa com várias complicações clínicas e está entre as maiores causas de morbidade e mortalidade no Brasil. A presença de comorbidades psiquiátricas, principalmente depressão e transtornos alimentares (TA), no paciente diabético, pode interferir no controle metabólico e aumentar as complicações da doença. Entre os vários fatores na associação entre o DM e os TA, aspectos psicológicos relacionados ao DM, assim como restrições dietéticas, desempenham função importante na expressão de comportamentos alimentares inadequados nesta população. O objetivo do presente artigo é apresentar uma atualização sobre a associação entre o DM e os TA. Serão descritos dados sobre a epidemiologia, fatores de risco, aspectos clínicos, evolução e tratamento da comorbidade entre os TA (anorexia nervosa, bulimia nervosa e transtorno da compulsão alimentar periódica) e DM tipos 1 e 2. O diagnóstico precoce e o tratamento adequado de um TA associado parece se correlacionar a um melhor prognóstico do DM.
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Affiliation(s)
| | - Marcelo Papelbaum
- Universidade Federal do Rio de Janeiro; Instituto Estadual de Diabetes e Endocrinologia do Rio de Janeiro, Brasil
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Rodin G, Olmsted MP, Rydall AC, Maharaj SI, Colton PA, Jones JM, Biancucci LA, Daneman D. Eating disorders in young women with type 1 diabetes mellitus. J Psychosom Res 2002; 53:943-9. [PMID: 12377307 DOI: 10.1016/s0022-3999(02)00305-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Research findings from the past decade regarding the association of type 1 diabetes mellitus and eating disorders are critically reviewed in this paper. Although there has been much debate regarding the specificity of this association, a recent large multisite case-controlled study demonstrated that the prevalence rates of both full syndrome and subthreshold eating disorders among adolescent and young adult women with diabetes are twice as high as in their nondiabetic peers. Further, a 4-year follow-up study showed that disordered eating behavior in young women with diabetes often persists and is associated with a threefold increase in the risk of diabetic retinopathy. These eating disturbances tend to be associated with impaired family functioning and with poor diabetes management. Health care professionals should maintain a high index of suspicion for the presence of an eating disturbance among young women with diabetes, particularly among those with persistently poor metabolic control and/or weight and shape concerns. Screening for such disturbances should begin during the prepubertal period among girls with diabetes. A brief psychoeducational intervention leads to a reduction in disturbed eating attitudes and behavior but is not sufficient to improve metabolic control. More intensive treatment approaches, which should include a family-based component, may be needed to improve metabolic control. The evaluation of these and other treatment approaches is indicated in view of the serious short- and long-term health risks associated with eating disorders in young women with diabetes.
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Affiliation(s)
- Gary Rodin
- Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Diabète insulino-dépendant et troubles des conduites alimentaires : quels progrès ? ANNALES MEDICO-PSYCHOLOGIQUES 2002. [DOI: 10.1016/s0003-4487(02)00234-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Takii M, Uchigata Y, Nozaki T, Nishikata H, Kawai K, Komaki G, Iwamoto Y, Kubok C. Classification of type 1 diabetic females with bulimia nervosa into subgroups according to purging behavior. Diabetes Care 2002; 25:1571-5. [PMID: 12196429 DOI: 10.2337/diacare.25.9.1571] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To classify type 1 diabetic females with bulimia nervosa (BN) by type of inappropriate compensatory behavior in order to prevent weight gain (ICB) and to investigate the group differences. RESEARCH DESIGN AND METHODS Type 1 diabetic females with BN, diagnosed by structured diagnostic interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) criteria, were classified by type of ICB as follows: 1) only severe insulin omission as an ICB (BN-I) (n = 22), 2) both severe insulin omission and self-induced vomiting and/or laxative abuse (BN-IP) (n = 22), or 3) no insulin omission but another ICB (BN-NI) (n = 11). The clinical characteristics of these three groups and a binge-eating disorder (BED) group (n = 24) were compared. RESULTS The BN-IP and BN-I groups had the highest HbA(1c) levels. The BN-IP group had the highest rates of diabetic neuropathy, retinopathy, and nephropathy. The BN-NI group had the second highest rates of neuropathy and retinopathy. The BN-IP group had the highest frequencies of diabetes- and ketoacidosis-related hospital admissions, and the BN-I group had the second highest frequencies. The BN-NI group showed the highest scores on psychological tests related to depression, anxiety, eating disorder psychopathology, and perfectionism. The BN-NI group had the highest rate of history of visits to a psychiatrist, and the BN-IP group had the second highest history. CONCLUSIONS Type 1 diabetic females with BN seem not to be homogenous and can be classified into three distinctive subgroups by type of ICB. Individuals with BN-IP had the most severe problems with both medical and psychological/behavioral aspects. Individuals with BN-NI manifested the highest psychological distress. The BN-I group had comparatively mild distress despite having the poorest metabolic control. Each BN group manifested more severe pathology than the BED group.
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Affiliation(s)
- Masato Takii
- Department of Psychosomatic Medicine, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.
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Takii M, Uchigata Y, Komaki G, Nozaki T, Kawai K, Nishikata H, Kawai H, Morioka K, Iwamoto Y, Kubo C. A cognitive/behavioral approach to type 1 diabetic females with recurrent binge eating: a 3-year follow-up study. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s0531-5131(02)00614-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Neumark-Sztainer D, Patterson J, Mellin A, Ackard DM, Utter J, Story M, Sockalosky J. Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: associations with sociodemographics, weight concerns, familial factors, and metabolic outcomes. Diabetes Care 2002; 25:1289-96. [PMID: 12145223 DOI: 10.2337/diacare.25.8.1289] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examines the prevalence of specific weight control practices/disordered eating behaviors and associations with sociodemographic characteristics, BMI and weight perceptions, family functioning, and metabolic control among adolescent females and males with type 1 diabetes. RESEARCH DESIGN AND METHODS The study population included 70 adolescent females and 73 adolescent males with type 1 diabetes who completed the AHEAD (Assessing Health and Eating among Adolescents with Diabetes) survey. Data on BMI and glycosylated hemoglobin (HbA(1c)) were drawn from medical records. RESULTS Unhealthy weight control practices were reported by 37.9% of the females and by 15.9% of the males. Among the females, 10.3% reported skipping insulin and 7.4% reported taking less insulin to control their weight. Only one male reported doing either of these behaviors. Weight control/disordered eating behaviors were not associated with age, parental level of education, family structure, or race/ethnicity. Higher levels of weight dissatisfaction tended to be associated with unhealthy weight control/disordered eating; associations with BMI were inconsistent. Family cohesion was negatively associated with disordered eating among females (r = -0.52; P < 0.001) and males (r = -0.41; P < 0.001), but correlations with other measures of family environment (control, independence, and responsibility for diabetes management) were not significant. Correlations between disordered eating and HbA(1c) levels were significant among females (r = 0.33; P < 0.01) and males (r = 0.26; P < 0.05). CONCLUSIONS Special attention is needed for youth with weight concerns and those from less cohesive families to assist in the development of healthy diabetes management behaviors.
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Affiliation(s)
- Dianne Neumark-Sztainer
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
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Nielsen S. Eating disorders in females with type 1 diabetes: an update of a meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2002. [DOI: 10.1002/erv.474] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Herpertz S, Albus C, Kielmann R, Hagemann-Patt H, Lichtblau K, Köhle K, Mann K, Senf W. Comorbidity of diabetes mellitus and eating disorders: a follow-up study. J Psychosom Res 2001; 51:673-8. [PMID: 11728508 DOI: 10.1016/s0022-3999(01)00246-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE There is increasing evidence that the coexistence of diabetes and eating disorders (ED) leads to poor glycemic control and an increased risk of long-term complications. METHODS In a questionnaire- and interview-based study, a sample of 36 out of originally 38 (94.7%) diabetic patients with an ED (type-1: n=13, type-2: n=23) was assessed after a period of about 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 consecutive weeks. Twenty-two patients (61.6%) showed no change in the diagnosis of the ED. Four patients (11.1%) shifted from subclinical to clinical EDs and five patients (13.9%) vice versa. Of the eight patients who went on to psychotherapy, only one patient (12.5%) showed full remission. Emotional distress 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 psychopathology 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 dissatisfaction. No considerable change could be observed with regard to BMI, glycemic control, and depressive and global psychiatric symptomatology in either diabetic subsample during follow-up. CONCLUSION EDs tended to persist over time with a considerable shift within the different types of EDs. Insulin-purging in type-1 diabetics was associated with enhanced psychopathology, higher BMI, and worse metabolic control. Both mean body mass and ED-related symptoms such as "drive for thinness" and "body dissatisfaction" increased in the average obese type-2 diabetic sample, illustrating the vicious circle of low self-esteem, enhanced restraint eating, and binge eating in weight control measures.
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Affiliation(s)
- S Herpertz
- Clinic of Psychotherapy and Psychosomatics, University of Essen, Postfach 103043, 45030 Essen, Germany.
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