Eating disorders and type 1 diabetes mellitus

Disturbances in eating attitudes and behaviour in adolescents and young adults with type 1 diabetes mellitus are of major clinical importance for a number of reasons. Firstly, this clinical group have available to them an additional weight-loss strategy, the under-use or omission of insulin. Secondly, they appear to be at a high risk of mortality and morbidity. Even a relatively brief period of poor control can produce a significant increase in the risk of subsequent microvascular complications. Sub-clinical eating disturbances, seen as relatively mild in non-diabetic patients, can give rise to clinically important disturbances of self-care and glycaemic control. In the short term, poor control may be manifest as recurrent symptoms of hyperglycaemia (e.g. thirst or tiredness), frequent episodes of ketoacidosis (often requiring hospital admission) or hypoglycaemia (leading to unconsciousness if severe). Growth retardation and pubertal delay may occur in prepubertal children. Patients with eating disorders and type 1 diabetes mellitus also appear to be at increased risk of physical complications of diabetes, including retinopathy, nephropathy or neuropathy. This contribution will discuss the ways in which clinical features, prevalence, clinical course, and diagnosis and management of eating disorders in such patients differ from those in non-diabetic populations.