ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Pediatr. 2019;207:205–2129.

Psychosocial issues and psychiatric disease are prevalent in young patients with type 1 diabetes (T1D). Most importantly, eating disorders, anxiety-related behavioral problems as well as depression have all been shown to occur (1). In a nationwide population-based survey, this group had previously reported on relationships between eating disorder and depressive symptoms and HbA1c levels (1). Screening positive for an eating disorder was associated with more severe depressive symptoms among women. However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (β 0.14, P=0.006). Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, regular mental health screening is recommended for young adults with T1D (1).

This study from the DPV group assessed indications of eating disorders in 31,556 T1D girls aged >6 months and <23 years, including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) with bulimia nervosa, 45 (0.14%) with binge eating disorder, and 229 (0.73%) with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes in HbA1c, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders using multiple logistic regression analyses.

Eating disorders were significantly associated with late pubertal age, non-usage of pumps, no migration background, higher HbA1c, and higher frequencies of DKA and severe hypoglycemia, but not to celiac disease. Importantly, the differences in HbA1c levels, prevalence of DKA and severe hypoglycemia were already detectable in the first years after onset of T1DM. A decrease in BMI-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6–14.3] compared with stable BMI-SDS, and 6.9-fold [95%CI 3.4–14.1] compared with increase of BMI-SDS.

In conclusion, girls with T1D should be monitored for the development of eating disorders starting immediately after T1D onset: poor metabolic control and higher rates of DKA and severe hypoglycemia in the first years after T1D onset are alarming signs. Weight loss after initiation of insulin treatment is specific for anorexia nervosa. Systematic screening for eating disorders and also depression especially at a late pubertal age in girls with T1D is recommended.

Reference: 1. Bächle C, Lange K, Stahl-Pehe A, Castillo K, Scheuing N, Holl RW, Giani G, Rosenbauer. Symptoms of Eating Disorders and Depression in Emerging (1) J. Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control. PLoS One. 2015;10:e0131027. doi: 10.1371/journal.pone.0131027.