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Mortality in Concurrent Type 1 Diabetes and Anorexia Nervosa

¹ Departments of Child and Adolescent Psychiatry F, H:S Bispebjerg Hospital, University of FSCopenhagen, Copenhagen, Denmark
² Psychiatric Demography, Institute for Basic Psychiatric Research, Psychiatric Hospital in Århus, Risskov, Denmark
³ Steno Diabetes Center, Gentofte, Denmark

OBJECTIVE—Previous studies in this field report early occurrence of diabetic complications, but excess mortality, though expectable, has not been reported. We combined information from earlier studies to estimate the mortality for this group of patients.

RESEARCH DESIGN AND METHODS—The observed mortality is analyzed using crude mortality rate (a percentage), standardized mortality ratio (SMR), incidence rate ratio, risk difference, and survival analysis.

RESULTS—After 10 years of follow-up, 13 of 510 females with type 1 diabetes, 43 of 658 females with anorexia nervosa (AN), and 8 of 23 concurrent case subjects had died. Mortality rate was 2.2 (per 1,000 person-years) for type 1 diabetes, 7.3 for AN cases, and 34.6 for concurrent cases. Crude mortality rates were 2.5, 6.5, and 34.8%, respectively. SMR was 4.06 in type 1 diabetes, 8.86 in AN, and 14.5 in concurrent cases. Survival analysis indicated between-group differences in mortality.

CONCLUSIONS—Concurrent type 1 diabetes and AN is a rare but serious condition in females. All indexes of mortality evidence excess mortality in this preliminary study. Vigorous and well-directed treatment efforts seem vital for this subpopulation. Collaboration between diabetologists and eating disorder specialists is warranted. The implications of other eating disorders and subclinical eating disorders in diabetic populations need to be analyzed, especially because these conditions are more frequent than clinical eating disorders.

Abbreviations: AN, anorexia nervosa • CMR, crude mortality rate • ED, eating disorder • ED-NOS, ED not otherwise specified • ICD, International Classification of Diseases • OR, odds ratio • RD, risk difference • RR, rate ratio • SMR, standardized mortality ratio

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