Eating Disorder Tied to Poor Diabetes Outcomes

A recent study found a correlation between binge eating and poor glycemic control in patients with type 2 diabetes mellitus (T2DM).

“Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) treatment and may have an impact on glycemic control,” the authors posited. “Previous reports showed elevated prevalence of eating disordered behaviors, especially binge eating disorder in clinical samples of type 2 diabetes patients. However, results regarding the impact of an eating disorder on the glycemic and clinical control of T2DM is inconsistent.”

These new findings were published in the Journal of Eating Disorders.

Seventy consecutive T2DM were evaluated using a Structured Clinical Interview for DSM-IV and the Binge Eating Scale. Fasting blood glucose (FBG) and glycated hemoglobin (A1c) levels were used to determine glycemic control. Body mass index (BMI) and lipids were also evaluated. Patients were compared for clinical and psychopathological characteristics based on eating disorder status. Linear regression analysis controlling for BMI was conducted.

The study cohort was primarily female (n = 54, 77%); mean BMI was 30.6 kg/m². Half of included patients were obese (mean BMI, 34.8 kg/m²). Just over half (51%) of patients were regular insulin user Overall, 14 (20%) patients were determined to have an eating disorder, the most prevalent of which was binge eating disorder (n = 7). Three patients presented bulimia nervosa, and four had an eating disorder not otherwise specified (EDNOS), with subclinical BED. Since eating disorders other than binge eating were underrepresented, the authors looked at the group as a whole.

Patients with a higher BMI were more likely to have an eating disorder compared to those with a normal BMI (26% vs. 8%); eating psychopathology severity was also positively correlated with BMI. Insulin use was similar whether patients did (50%) or did not (52%) have an ED.

When comparing the patient populations before considering BMI, there was an association between eating disorder status and FBG and A1c levels. However, when adding BMI into the models, eating disorder status no longer impacted glycemic control.

The study authors observed that “patients with comorbid ED had a poorer glycemic control compared to those with normal eating behaviors, not related specifically to age or duration of diabetes. However, when including BMI in the regression model, the impact of eating psychopathology on A1c and FBG disappeared, showing that body weight may play a major role modulating the relationship between ED disturbances and glycemic control.”

The researchers stated in their conclusion, “The pool of evidence regarding the association between ED and T2DM seems to justify screening diabetic patients for abnormal eating behaviors. In addition, when obesity is present, eating psychopathology investigation is even more recommended, since it may disrupt obesity treatment and indirectly affect diabetes control.”