Worse Metabolic Control and Dynamics of Weight Status in Adolescent Girls Point to Eating Disorders in the First Years after Manifestation of Type 1 Diabetes Mellitus: Findings from the Diabetes Patienten Verlaufsdokumentation Registry.

Abstract

OBJECTIVE:

To assess indications of eating disorders in girls with type 1 diabetes mellitus (T1DM).

STUDY DESIGN:

In total 31 556 girls aged >6 months and <23 years of age with T1DM from the Diabetes Patienten Verlaufsdokumentation (DPV) cohort were analyzed including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) girls with bulimia nervosa, 45 (0.14%) girls with binge eating disorder, and 229 (0.73%) girls with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes of glycosylated hemoglobin A1c (HbA1c) levels, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders. Multiple logistic regression analyses were performed.

RESULTS:

Eating disorders were significantly associated with late pubertal age, nonusage of pumps, no migration background, increased HbA1c levels, increased frequencies of DKA and severe hypoglycemia, and celiac disease were not related to eating disorders. Significant differences in HbA1c levels, prevalence of DKA and severe hypoglycemia between girls with and without eating disorders were already detectable in the first years after onset of T1DM. A decrease of body mass index (BMI)-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6-14.3] compared with stable BMI-SDS, 6.9-fold [95%CI 3.4-14.1] compared with increase of BMI-SDS).

CONCLUSIONS:

Poor metabolic control and increased rates of DKA and severe hypoglycemia in the first years after manifestation of T1DM can be hints for eating disorders in girls with T1DM, and weight loss is specific for anorexia nervosa. These clinical features should lead to screening for eating disorders especially at a late pubertal age.

• Authors: Thomas Reinehr, Barbara Dieris, Angela Galler, Martin Teufel, Gabriele Berger, Rainer Stachow, Sven Golembowski, Ute Ohlenschläger, Martin Holder, Michael Hummel, Reinhard W Holl, Nicole Prinz
• Journal: The Journal of pediatrics (J Pediatr) Vol. 207 Pg. 205-212.e5 (04 2019) ISSN: 1097-6833 [Electronic] United States
• PMID: 30579582 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Glycated Hemoglobin A

Topics

• Adolescent
• Body Weight (physiology)
• Child
• Diabetes Mellitus, Type 1 (blood, epidemiology, etiology)
• Feeding and Eating Disorders (complications, epidemiology, physiopathology)
• Female
• Follow-Up Studies
• Germany (epidemiology)
• Glycated Hemoglobin (metabolism)
• Humans
• Prevalence
• Prospective Studies
• Registries
• Risk Assessment (methods)
• Risk Factors