An Australian study has found almost a third of patients with type 1 diabetes have disordered eating comprising some risky behaviours such as insulin modification to induced hyperglycaemia, glycosuria and weight loss.

The study of 199 patients attending the young adult or general adult diabetes clinics at a Melbourne Hospital found 31% met the criteria for disordered eating on the 16-item Diabetes Eating Problem Survey-Revised (DEPS-R).

People with disordered eating were more likely to be female, overweight or obese and have a higher HbA1c.

Most patients with disordered eating reported a desire to lose weight (82%), eating more when alone (59%) and having difficulty with diabetes and weight management simultaneously (80.6%).

More than a third (38.1%) reported irregular meal patterns.

“Although such eating behaviours may be considered as low risk of harm concerning short-term diabetes management, the risk increases if these behaviours occur frequently. In addition, these behaviours can manifest into maladaptive weight management strategies in the longer term and early preventative measures must be considered,” the study said.

Demonstrated risky behaviours were less common but included insulin omission in response to overeating (25.8%), purging (8.1%) or binge eating (3.2%).

The investigators said there were strong negative implications for overall diabetes management and risk of diabetes-related complications, such as DKA, if such behaviours were not identified and addressed.

“Regular screening for disordered eating should be incorporated into routine care and a multidisciplinary team approach should be used.”

A limitation of the study was that the DEPS-R has previously only been validated in an adolescent population.

“However, the DEPS-R does identify individuals who require further detailed assessments of diet and lifestyle practices and may benefit from dietetic intervention.”

“In addition to providing a signal for disordered eating behaviours, the DEPS-R screening tool has potential to facilitate individualised conversations, assessment and management of identified concerning behaviours.”

Mixed messages

Co-investigator on the study Andrea Bramley, a dietician and allied health education lead at Monash Health, told the limbic that diet was a cornerstone of diabetes management but there was no single diet that was right for everyone.

“It’s really complicated and what prompted this study was what felt like a flood of people coming through the clinic who had either disordered eating or an actual eating disorder.”

“People with diabetes have got that extra capacity to manipulate insulin and it’s not healthy or helpful in the long term. It can become appealing if someone is really struggling but it’s counterproductive.”

She said what was really challenging was the plethora of mixed messages that can drive unhealthy relationships with food and be quite unproductive.

“Everyone has an opinion and people with diabetes have to manage those …whether it is from a medical professional or a family member or a friend or a newspaper.”

“For example, some people do really well on intermittent fasting but other people may not do so well because they are denying themselves food,” she said.

Ms Bramley said clinicians managing patients with diabetes should have the possibility of disordered eating on their radar.

“While the screening tool wasn’t perfect, it was a way of opening conversations and particularly if there is a suspicion that the patient is experiencing some form of diabetes distress. Food can be part of that as well.”

She said conversations about weight loss and different strategies open to people should be conducted in a sensitive and non judgemental manner. Referral to a dietician was recommended to help patients determine what patterns of eating best suit them, to help them try different options and appropriately monitor them.

The study was published in Health and Social Care in the Community.