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How Disordered Eating and Diabetes are Related

Feb 20, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Sandra Zaki, PharmD Candidate, Florida A&M University

People with diabetes may be predisposed to a variety of disordered eating patterns, such as binge eating. 

Diabetes is a disease that affects people who have defective pancreatic insulin-producing cells. Diabetes has been associated with depressive disorders, mainly because of the glucose management procedures and limitations that it brings with it. People with diabetes have to watch what they eat to avoid raising their blood glucose levels, take their prescribed insulin or other medications, and, for acute cases, occasionally scheduled hemodialysis. For some people dealing with depression or other mental stresses linked with diabetes, eating may become a coping mechanism, which gives rise to yet another problem, disordered eating. Previous studies have shown that eating disorders were more prevalent among people with type 1 diabetes in the United Kingdom. This was wholly or partially attributed to the restriction of insulin for type 1 diabetes patients for weight regulation purposes. This review looks at previous research on this subject and tries to establish a relationship and prevalence of eating disorders in both type 1 and type 2 diabetes. 

 

Studies from the past 25 years were compiled for this review, and some of the most notable findings were documented. It is known that disordered eating is prevalent among people with diabetes, especially females. This prevalence has only risen in the 21st century, although attributed to the different study designs and base characteristics of varying sample groups. There is a high risk involved with food disorders, such as the risk of ketoacidosis. This risk is elevated in the case of type 1 diabetes. In type 2 diabetes, studies focus on over-eating as the primary type of eating disorder. This is due to the close relationship between type 2 diabetes and weight gain. A 2001 survey showed people with type 2 diabetes have a 26% prevalence for binge eating.  

Some other factors that contribute to eating disorders in people with diabetes include elements specific to diabetes conditions. These factors are closely related to the pathophysiology of the disease. Significant weight loss prior to diagnosis of type 1 diabetes is common and results in the body going to a state of catabolism, and dehydration is frequent due to glycosuria. This rapid loss of weight in type 1 diabetes can shortly be followed by a rapid increase in weight when insulin treatment is administered. 

Psychosocial factors also contribute to eating disorders in people with diabetes. They include depression, and anxiety has been observed in people with type 1 and 2 diabetes. Two studies showed that negative emotions result in restriction of insulin production, which leads to binge eating. This indicates psychological and social interaction states as risk factors for the development of eating disorders in people with diabetes. Disordered eating has been linked to a lower quality of life with manifestations of anxiety and depression in people with type 1 and type 2 diabetes. 

The treatment for disordered eating is limited. However, there are some interventions, though few have been proven to be effective. They are largely based on the psychological therapies that seek to find and probe the cognitions that affect disordered eating. However, the interventions did not touch on any form of diabetes-related effects or self-management solutions for people with diabetes suffering from disordered eating. Due to the lack of incorporation of diabetes in the treatment of eating disorders, glycemic regulation of patients with diabetes and disordered eating was not improved.  

These complied studies contain a wealth of knowledge and starting points for more research. However, they contain some significant gaps in knowledge required for treating people with diabetes and disordered eating comorbidity. There is a need for more flexible research techniques that will lead to improvements in the comprehension of the main risk factors and progression of eating disorders in diabetes. 

Practice Pearls: 

  • Binge eating is a sign of an eating disorder and can lead to weight gain, especially for people with diabetes. 
  • Both types of diabetes are risk factors for disordered eating, with a higher risk for women than men. 
  • Depression, anxiety, family-related social interactions, body shape, and body weight may contribute to disordered eating. 

 

Broadley, M. M., Zaremba, N., 25 Years of psychological research investigating disordered eating in people with diabetes: what have we learned? DIABETIC Medicine. PSAD Special Issue Paper DOI: 10.1111/dme.14197 

 

Sandra Zaki, PharmD Candidate, Florida A&M University