Eating Disorders and Type 1 Diabetes

What's New in Diabetes Research?

The drive to discover new and innovative solutions for managing diabetes is international. The Diabetes UK Professional Conference, held in Glasgow in March 2016, presented many of these advances and developments, including new insights into diabulimia; the role of mindfulness in diabetes management; risk factors for Type 2 diabetes in the younger generations; and new discoveries in glucose monitoring and management. Through interviews conducted with the presenters of these topics, Dr. Nicola Davies explores the latest innovations in diabetes research.

In this installment, we look at eating disorders and Type 1 diabetes.

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Diabulimia is a dual-diagnosis disorder — diabetes and bulimia nervosa. According to Jacqueline Allen, PhD, researcher at Birkbeck University of London, “Diabulimia is the induction of hyperglycemia or diabetic ketoacidosis through the omission of insulin, specifically for weight loss purposes.” In other words, a person suffering from diabulimia purposefully takes less insulin than is required to induce hyperglycemia or diabetic ketoacidosis. This is because insulin deficiency can trigger weight loss, which motivates those suffering from diabulimia to deliberately take less insulin than they need. This eating disorder is exclusive to people with Type 1 diabetes.

Allen says, “Prevalence rates vary from 20 to 60% of Type 1 females between the ages of 15 and 30, and although little research has been conducted using males, we also know that they have a ‘higher drive for thinness’ than their non-Type 1 counterparts.” She notes that the rates of different forms of eating disorders in people with Type 1 diabetes, outside of diabulimia, are also much higher than rates in the general population.

The debilitating long-term effects of diabulimia, which are the same as those seen with ineffective administration of insulin or lack of management of Type 1 diabetes, include chronic kidney failure, heart disease, stroke, and eye damage. The trade-off between the short-term benefit of weight loss that motivates those with diabulimia is severely undercut by the long-term harm that can be sustained by the perpetual misuse of insulin.

Allen has been studying the psychological risk factors involved in people with Type 1 diabetes developing diabulimia. “There appears to be a general psychological vulnerability in those who develop diabulimia, but anxiety and perfectionism coupled with issues in the clinic environment are particularly important,” she explains. She is still analyzing the data from her research, but shares that, “High family cohesion seems to protect to a certain extent.”

When it comes to treating diabulimia, health-care providers need to keep in mind that they are dealing with a two-pronged problem that requires treatment as a whole. If thoughts and feelings surrounding insulin and diabetes are treated independently of the eating disorder, then any treatment is likely to fail. Allen says, “I am planning on running a six-month online intervention based on the risk and protective factors to see if I can improve biopsychosocial [biological, psychological, and social] outcomes in those who have diabulimia. It is completely anonymous and connects patients to health-care providers via a text chat room in live time. It’s a new concept using brand new technology specifically developed for the project.” For those struggling to break free from the dangerous practice of manipulating their insulin for weight loss, this study is one to watch.

Looking to the future

Researchers continue to develop new treatments to assist the almost 620 million people worldwide with various forms of diabetes. The Diabetes UK Professional Conference kept attendees abreast of current developments in the field. The sessions were invaluable for increasing awareness regarding troubling trends in the diabetes community or developing new methods or technologies to help people with diabetes manage and monitor their condition. The insights provided predict a future with greater public awareness of the risk of unhealthy lifestyles, a higher standard of care that can be provided by practitioners and a higher quality of life for people with diabetes.