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Eating Disorders Negative Effect on Glycemic Control

Mar 10, 2018

An attempt to improve diet quality in youth with type 1 yields less than promising results.

Disordered eating behaviors (DEBs) can be classified as eating too much or eating too little.


Our youth with type 1 diabetes (T1D) have shown to be more vulnerable to this diet issue in comparison to their peers due to the demand required to manage carbohydrate-insulin ratios. Insulin relationship to weight-gain also poses a threat to this population. Adolescents with T1D and DEBs are so focused on weight loss that they tend to skip meals, purge meals, insulin restrict, and omit. Behavioral nutrition interventions have been conducted to help improve this disorder. Due to the increased attention to dietary intake with this type of intervention, DEBs tend to be intensified with studied populations. Previous studies have shown a relationship between DEBs, higher HbA1c levels, and the development of retinopathy. There is a lack of prospective studies addressing 1) glycemic control and variability associated to DEBs and 2) how to successfully improve diet quality without indirect exacerbating DEBs. Addressing these relationships can provide considerable advances in the understanding of adverse effects caused by DEBs in youth with T1D.

Miriam Colman et al. conducted a family-based behavioral nutrition intervention that focused on dietary monitoring, meal prepping, and classes about whole foods. Inclusion criteria were: 8-16.9 years of age, at least one year of T1D diagnosis, HbA1c 6.5-10%, daily insulin injection of ³0.5 units/kg divided into three or more injections or pumps, and must speak English. The intervention group received monthly nutrition coaching sessions and social eating advice. The control group received less attentive dietary coaching and goal-oriented “core” sessions. The main objectives were to see if behavioral nutrition interventions increased DEB and to examine the relationship between DEB and biomarkers of glycemic control/variability over 18 months. Assessments were conducted at baseline, 6 months, 12 months and 18 months. Glycemic control was assessed by measured HbA1c levels and sensor glucose values; while diabetes management, DEBs, demographic and biomedical data were reported via questionnaires.

This study successfully improved diet quality in youth with T1D without any influence on glycemic control. There were no differences in reported DEBs between the intervention vs. the control group (P >0.07). Higher reported DEBs were associated with higher HbA1c (0.001), resulting in poorer glycemic control and diabetes management. Higher reported DEBs were also associated with higher mean sensor glucose values (P=0.001).

In conclusion, family-based behavioral nutrition interventions help to improve diet quality in adolescents with T1D and DEBs. This study also showed the trending association between DEBs and hyperglycemia, elevated HbA1c levels, mean sensor glucose, and overall poor diabetes management. DEBs connection to chronic hyperglycemia with little or no relation to hypoglycemia or glycemic variation strongly proved intentional insulin omission is used to force unhealthy weight loss in adolescents. Outcomes of this study should serve as encouragement for healthcare providers to provide quality diet   advice and education to all patients. Most patients need further education on healthy eating and what whole plant foods are, instead of hard dietary restrictions. Support from parents and other family members also provides an added benefit on achieving success in these type of interventions. Study strengths include: study design, statistical power, use of diabetes specific measurements. A limitation of this study was the lack of generalizability. Selected participants were white, English speaking adolescents. Future studies should broaden their participant pool to reproduce this observational analysis and further differentiate power of associations to DEBs. Along with more observational studies, qualitative studies can also be beneficial.

Practice Pearls:

  • Disordered eating behaviors can be classified as eating too much or eating too little.
  • Successful diet interventions are possible without worsening DEBs in adolescents.
  • Better results are seen when patients are educated about healthy eating habits and what whole foods are, instead of focusing on dietary restrictions.


Colman, Miriam H. Eisenberg, et al. “Disordered Eating Behaviors Are Not Increased by an Intervention to Improve Diet Quality but Are Associated With Poorer Glycemic Control Among Youth With Type 1 Diabetes.” Diabetes Care, 25 Jan. 2018, p. dc170090., doi:10.2337/dc17-0090.

Adrianna Jackson, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy