Comorbid Type 1 Diabetes and Eating Disorders
Comorbid Type 1 Diabetes and Eating Disorders
The aim of the study was to identify clinical differences and treatment outcome between individuals with eating disorders and T1DM and those without diabetes. Eating disorders, particularly BN has been previous associated to T1DM. The association between both conditions is so clear that a new term, which is not yet a medically recognized condition, has recently been described in the literature, Diabulimia. This condition has been particularly described among the adolescent population, as weight management during this time of development for individuals with diabetes can be particularly difficult forcing them to restrict or omit insulin. Our study confirms the misuse of insulin among this population. The lack of difference in purging behavior and the differences in self-harm and suicidal behaviour between the two groups may point towards the importance of analyzing the role of insulin misuse in this population. For example, the lower number of self-harm behaviours in patients with T1DM may indicate that patients with this condition may not require the use of self-harm in order to deal with emotions as they may use insulin misuse instead. It can be hypothesized that insulin omission, which leads to weight loss, is more closely connected to mood regulation and self-harm behaviour than to weight and shape issues, although this will need to be researched further. This could explain the difficulties that T1DM patients may have in stopping insulin abuse, as recently noted, and the poor motivation of these individuals as manifested by high number of treatment dropouts found in this study.
ED patients with T1DM were found to dropout more frequently and sooner than patients without diabetes. The study found that treatment outcome for T1DM patients was overall worse than for individuals without diabetes. Motivation levels and personality traits (low persistence and accomplishment levels), could explain these results, as suggested in studies with DM patients. The fact that individuals with T1DM present with low persistence which is associated to low frustration tolerance and low perseverance may explain the high levels of dropouts and the poor outcomes found among these individuals. That and will suggest the need for interventions to be modified for this population and for diabetologies to be informed about the risk of poor outcome that patients with both conditions present. The lack of motivation for change found among individuals with T1DM may also be a reflection of the low levels of consciousness regarding the illness, the low perceived intensity and low perceived impairment which suggests the importance of working using Motivational Enhancement interventions with individuals with T1DM and ED.
Although there is clear evidence that T1DM are particularly associated with BN, this study has included all type of eating disorders. Future studies may want to focus in exploring the outcome of patients with T1DM and BN only. Moreover, future studies may also want to consider investigating whether the presence of comorbid diabetes impacts motivation to treatment per se. Although the study is limited by sample size, the patient's reliability about self-reporting insulin underdosing and the possible influence of T1DM on ED questionnaires, the current study has addressed treatment response and dropout rates of CBT therapy across the ED patients with T1DM which, to our knowledge, has not been previously investigated.
Discussion
The aim of the study was to identify clinical differences and treatment outcome between individuals with eating disorders and T1DM and those without diabetes. Eating disorders, particularly BN has been previous associated to T1DM. The association between both conditions is so clear that a new term, which is not yet a medically recognized condition, has recently been described in the literature, Diabulimia. This condition has been particularly described among the adolescent population, as weight management during this time of development for individuals with diabetes can be particularly difficult forcing them to restrict or omit insulin. Our study confirms the misuse of insulin among this population. The lack of difference in purging behavior and the differences in self-harm and suicidal behaviour between the two groups may point towards the importance of analyzing the role of insulin misuse in this population. For example, the lower number of self-harm behaviours in patients with T1DM may indicate that patients with this condition may not require the use of self-harm in order to deal with emotions as they may use insulin misuse instead. It can be hypothesized that insulin omission, which leads to weight loss, is more closely connected to mood regulation and self-harm behaviour than to weight and shape issues, although this will need to be researched further. This could explain the difficulties that T1DM patients may have in stopping insulin abuse, as recently noted, and the poor motivation of these individuals as manifested by high number of treatment dropouts found in this study.
ED patients with T1DM were found to dropout more frequently and sooner than patients without diabetes. The study found that treatment outcome for T1DM patients was overall worse than for individuals without diabetes. Motivation levels and personality traits (low persistence and accomplishment levels), could explain these results, as suggested in studies with DM patients. The fact that individuals with T1DM present with low persistence which is associated to low frustration tolerance and low perseverance may explain the high levels of dropouts and the poor outcomes found among these individuals. That and will suggest the need for interventions to be modified for this population and for diabetologies to be informed about the risk of poor outcome that patients with both conditions present. The lack of motivation for change found among individuals with T1DM may also be a reflection of the low levels of consciousness regarding the illness, the low perceived intensity and low perceived impairment which suggests the importance of working using Motivational Enhancement interventions with individuals with T1DM and ED.
Although there is clear evidence that T1DM are particularly associated with BN, this study has included all type of eating disorders. Future studies may want to focus in exploring the outcome of patients with T1DM and BN only. Moreover, future studies may also want to consider investigating whether the presence of comorbid diabetes impacts motivation to treatment per se. Although the study is limited by sample size, the patient's reliability about self-reporting insulin underdosing and the possible influence of T1DM on ED questionnaires, the current study has addressed treatment response and dropout rates of CBT therapy across the ED patients with T1DM which, to our knowledge, has not been previously investigated.
