Fréquence et gravité des troubles du comportement alimentaire chez les jeunes diabétiques de type 1 : revue de la littérature

Eating disorders (ED) of young diabetics have been the subject of many publications for the last twenty years. They have been especially studied in the case of young girls in the pre-adolescent period or during adolescence. These eating disorders are part of DSM-IV classification: anorexia nervosa, bulimia nervosa or non other specified disorders (NOSD) where a clinical sign in the above mentioned diseases is lacking. An example of NOSD is “binge eating disorder”. Other more moderate ED, not classified in the DSM-IV have also been described. Ten case-control studies showed that anorexia nervosa does not appear frequently with diabetes, but when it does appear, mortality is very frequent. All the other ED are statistically more frequent with diabetes, especially binge eating disorder and the moderate ED which are not included in the DSM-IV. Purging behaviour, including insulin omission is equally frequent with young diabetics when weight must be controlled. This, will result in an increase of the HbA1C and more of chronic complications, especially retinopathy. Two principal factors seem to enter into the appearance of the ED. First, weight, often higher than in control cases, where regulation can contribute to the apparition of ED to compensate for insulin omission. Then, bad familial environment, without really knowing if this is found more often with diabetes, or with ED control subjects. Several studies have shown that a follow up of ED is possible and efficient, but also, that ED are not always necessary in a certain number of cases, when more care is taken with young diabetics when the metabolic control is and continues to be mediocre.