Disordered Eating Behavior in Individuals With Diabetes

This review was conducted to examine disordered eating behavior (DEB), including diagnosable eating disorders, in the context of diabetes. The use of criteria and assessment methods standardized on the healthy population is examined. Also considered is the need for modified assessment methods and classification of this behavior when evaluating patients with diabetes. Future directions for research are suggested. Literature published from 1980 to present was examined using “eating disorders and diabetes” as search terms. Over 100 peer-reviewed articles were identified via PubMed, Cochrane Reviews, PsycInfo, etc. Bibliographies from articles were reviewed to ascertain additional publications. Cited articles include reviews and individual studies indicating experimental design (self as control, healthy control, or population estimate), assessment methods (self-report, questionnaires, and structured/clinical interviews), and use of standard diagnostic criteria. Not all relevant articles could be included. However, some older references (published before 2000) are included because they provide foundation literature from which our understanding of DEB in the population of patients with diabetes derives and/or are validation studies for measurement methods. Additional references pertinent to hypothesized mechanisms are cited. Most studies, including those in a 2005 meta-analysis ( N = 8 case-controlled studies), tend to focus on young women with type 1 diabetes, usually between ages 15–35 years, when weight concerns, DEB, and eating disorders are at a high prevalence (1). Recent studies have included type 2 diabetic patients, minorities, and male patients (2–9). The diagnosis of diabetes has been associated with elevated rates of DEB and eating disorders, particularly when insulin omission is considered purging (1,8–11). Diagnosed eating disorders and subclinical DEB have been associated with poorer health in individuals with type 1 diabetes. Early reports found prevalence rates of the co-occurrence of diabetes and DEB to be low and accompanied by psychiatric comorbidity and weight …