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Eating Disorders in Children and Teens with Type 1 Diabetes 1984-ongoing Denis Daneman University of Toronto And The Hospital for Sick Children

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ED Classification Clinical/full-blown: DSM-lV: Anorexia nervosa Bulimia nervosa Eating Disorder Not Otherwise Specified (EDNOS) Subthreshold (not subclinical) Disturbed Eating Behavior that does not meet criteria for full-blown ED, but with clinical consequences (e.g. A1c, complications)

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Eating Disorders: Core Features : Body dissatisfaction Drive for thinness Dietary restraint Diabetes-specific vulnerabilities: Insulin-related weight gain Nutritional counseling Poor self-esteem Individual, family, and societal factors Disordered eating attitudes and behavior: Insulin omission Binge eating Dieting Diabetes-specific outcomes: Poor metabolic control: high HbA1c Microvascular complications, e.g., retinopathy Working Model : Rodin & Daneman 1992

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Predictions arising from our model: 1.Prevalence 2.Natural history 3.Associated with poorer control specific behavior, especially insulin omission early complications specific family issues 4.Difficult to treat

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Jones et al, BMJ 2000: DSM-IV diagnosable ED DM: 356 DSM-IV: 36 (10%) AN 0 (0) BN 5 (1.4) NOS 31 (8.7) Controls: 1098 (3:1) 49 (4%) those without

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FIVE-YEAR FOLLOW-UP 13.3% of participants (13/98) met criteria for an ED 3 girls had bulimia nervosa 3 had ED-NOS 7 had a subthreshold ED 44.9% of participants were classified as overweight or obese

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FIVE-YEAR FOLLOW-UP A1c not higher in girls with DEB (8.7% vs. 8.4%; p = 0.11) Trend for higher A1c in those with an ED (9.1% vs. 8.5%; p = 0.08) BMI higher in those with DEB (26.1 versus 23.5; p = 0.001)

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ED POINT PREVALENCE & CUMULATIVE PREVALENCE BY AGE

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FIVE-YEAR FOLLOW-UP Higher BMI and DEB were strongly associated, which presents a management dilemma Both dietary restraint and higher weight are risk factors for the development of ED and their negative health consequences

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PREDICTION OF THE ONSET OF DISTURBED EATING BEHAVIOUR IN ADOLESCENT GIRLS WITH TYPE 1 DIABETES

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LOGISTIC REGRESSION MODEL WITH BACKWARD STEPWISE REGRESSION Dietary Restraint Weight & Shape Concern Physical Appearance Self-Worth Depression X 2 = 43.254, df = 5, p