medwireNews: The presence of an eating disorder diagnosis significantly increases the risk for diabetic ketoacidosis (DKA) and all-cause mortality in adolescents and young adults with type 1 diabetes, shows a population-based study.
The findings emphasize “that adolescents and young adults with type 1 diabetes and concurrent eating disorders represent a high-risk group for both DKA and premature death as compared with peers without eating disorders,” write the researchers in Diabetes Care.
“It is important to incorporate screening tools for disordered eating behavior into routine type 1 diabetes care to allow for timely identification of such patients and to consider eating disorders as a reason for poor glycemic control, potentially due to insulin withholding.”
The researchers used Ontario health records to identify 20,035 adolescents and young adults (aged 10–39 years) with type 1 diabetes, 0.8% of whom had an eating disorder diagnosis.
This prevalence was higher than the 0.2% observed among young people without diabetes, note Baiju Shah (University of Toronto, Ontario, Canada) and study co-authors.
The 168 people with type 1 diabetes and an eating disorder were matched by age and sex with 1680 people with diabetes but no diagnosed eating disorder, and the unadjusted rates of DKA in these two groups were 112.5 versus 30.8 per 1000 person–years, respectively.
The team found that people with an eating disorder diagnosis “were overwhelmingly female,” at 92.9%.
These young women with eating disorders had a significant 3.41-fold increased risk for DKA, relative to women without, after accounting for income, rural versus urban residence, and diabetes duration. This was larger than the risk increase observed in young men with versus without eating disorders, which was a nonsignificant 2.47-fold.
Conversely, the risk for dying of any cause, while elevated in both sexes with eating disorders, was markedly higher in men than women, at 14.17-fold and 5.38-fold increases versus men and women without eating disorder diagnoses, respectively.
The mortality rates were 16.0 versus 2.5 per 1000 person–years in people with type 1 diabetes with and without an eating disorder, and the corresponding rates in people without diabetes were 2.5 and 0.4 per 1000 person–years.
“Although the absolute mortality risk was much higher for people with type 1 diabetes compared with those without, the relative impact of eating disorders was essentially similar,” observe Shah and team.
The researchers conclude that “regular screening for eating disorder symptoms in young individuals with type 1 diabetes, early referral for mental health evaluation, and the development and evaluation of interventions to prevent these outcomes for these high-risk patients are all warranted.”
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