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Diabetes Care 26:2695, 2003
© 2003 by the American Diabetes Association, Inc.

Letters: Observations
Letter

Eating Disorders in 12- to 16-Year-Old Diabetic and Nondiabetic Adolescents From Barcelona, Spain

Norma García-Reyna1, Sandra Gussinyer1, Miquel Gussinyer, MD1, Rosa Raich, PHD2, Josep Tomás, MD, PHD1 and Antonio Carrascosa, MD, PHD1

1 Department of Pediatrics, Vall d’Hebron Hospital, Barcelona, Spain
2 Department of Psychology, Autonomous University Barcelona, Barcelona, Spain

Address correspondence to Antonio Carrascosa, Vall d’Hebron Hospital, Pediatric Department, Pg. Vall d’ Hebron, 119-129, Barcelona 08035, Spain. E-mail: ancarrascosa{at}vhebron.net

Although eating disorders are common in late adolescent diabetic patients, the occurrence in younger populations, particularly male diabetic patients, is not well documented (1,2). The prevalence was studied in 60 boys and 38 girls (13.78 ± 1.05 years of age, range 12–16) with diabetes duration 1.5 ± 3.35 years and in 321 boys and 254 girls as nondiabetic peers (13.73 ± 0.63 years of age, 12–16).

Patients and peers completed the Spanish validated version of the Eating Attitudes Test (EAT-40) (3). The semistructured Eating Disorder Examination (EDE) interview (4) was held for those with an EAT-40 >30 (13 diabetic patients and 57 nondiabetic peers) and an additional randomly selected population (24 diabetic patients and 57 nondiabetic peers) with an EAT-40 score <30. Eating disorders were classified as clinical (5) and subthreshold (1). SPSS version 9.0 was used for statistical analysis.

No cases of anorexia or bulimia were found. Eating disorders not otherwise specified (EDNOS) were more prevalent in diabetic patients than in peers: boys (1.7 vs. 0.9%, odds ratio 1.7, CI 95% 0.2–17.6) and girls (5.3 vs. 1.6%, 3.2, 0.62–17.2). Subthreshold eating disorders were more prevalent in male diabetic patients than in nondiabetic peers (10 vs. 4.4%, 2.4, 0.9–6.6), with no differences between female diabetic patients and nondiabetic peers (10.5 vs. 9.9%, 1.1, 0.4–3.2). Male diabetic patients had 2.4 times increased risk for subthreshold eating disorders than nondiabetic peers. No eating disorders were observed in the 24 diabetic patients and 57 nondiabetic peers with EAT-40 scores <30. Glycated hemoglobin values were higher in diabetic patients with eating disorders (9.8 ± 0.42 and 5.63 ± 2.76%, n = 13) than in those without (8.4 ± 1.5 and 5.09 ± 2.73%, n = 85) (P = 0.049).

Although no cases of anorexia or bulimia were found, EDNOS and subthreshold eating disorders were detected in younger diabetic patients of both sexes. The higher glycated hemoglobin levels found in diabetic patients with eating disorders suggest poor metabolic control and increased risk for later vascular complications (6). Further studies including large series of patients are necessary to confirm these preliminary results; however, our data underline the need for careful surveillance in young diabetic patients of both sexes in order to promptly detect and prevent these incipient eating disorders.

References

  1. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G: Eating disorders in adolescent female with and without type 1 diabetes: cross sectional study. BMJ 320:1563–1566, 2000[Abstract/Free Full Text]
  2. Meltzer LJ, Jonson SB, Prine JM, Banks RA, Desrosiers PM, Silverstein JH: Disordered eating, body mass, and glycemic control in adolescents with type 1 diabetes. Diabetes Care 24:678–682, 2001[Abstract/Free Full Text]
  3. Castro J, Toro J, Salamero M, Guimerà E: The eating attitudes test: validation of the Spanish version. Psychology Assessm 7:175–190, 1991
  4. Cooper Z, Fairburn CG: The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 6:1–8, 1987
  5. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC, American Psychiatric Association, 1994
  6. Rydall AC, Rodin GM, Daneman D: Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 336:1849–1854, 1997[Abstract/Free Full Text]

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This Article
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