Introduction: The misuse or deliberate restriction of insulin for the purpose of weight loss is commonly referred to in the media and on social media as Diabulimia1, but this is not a medical definition. The relationship that young people with Type 1 Diabetes have with their weight, food and insulin is a commonly discussed, frequently studied but poorly understood issue. Mental health difficulties, especially eating disorders are common amongst adolescents2, and particularly in those with chronic health conditions3. Dietary restriction alongside poor glycaemic control during this period of rapid growth and metabolic changes have protracted consequences on long term health outcomes4,5. Eating disorders (7% vs 2.8%) and disordered eating patterns (39.3 vs 32.5%) are not unique to persons with diabetes (PWD)6. However, insulin restriction provides young people with Diabetes a unique and dangerous purging tool. The consequences of eating disorders in diabetes carry the high mortality and morbidity risks of eating disorders alongside a 4-fold increased risk of diabetes related complications and 3 fold risk of death7. Understanding and supporting PWD those who have difficult relationships with body image, food and insulin is a challenge for many health professionals. Joint working remains the cornerstone of clinical guidance8,9, however the practice of this is yet to be formally established in many areas.
Objectives: To understand incidence of disordered eating in Diabetes.
To explore mortality and morbidity data.
To increase understanding of the presentation of eating disorders in Diabetes.
To encourage cultural changes and body positive language.
Hopes for the future: Ongoing media and societal views around weight, shape and health are likely to continue to fuel a societal dissatisfaction with body and self. The misuse of insulin for weight loss is a topic which needs to be discussed, understood and young people supported through a journey.
Prevention embedded into structured education.
Seamless transition to adult services.
Joined up working between medical and mental health services.
Ongoing service improvement projects, language training and body positivity across all disciplines.
References: 1. Diabetics With Eating Disorders [internet]. Available from http://dwed.org.uk/about-us-faq
2. Inchley J, Currie D. Growing up unequal: gender and socioeconomic differences in young peoples health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the. 2013;2014:2.
3. Colton P, Olmsted M, Daneman D, Rydall A, Rodin G. Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes: a case-controlled study. Diabetes Care. 2004 Jul 1;27(7):16549.
4. Cho YH, Craig ME, Hing S, Gallego PH, Poon M, Chan A, Donaghue KC. Microvascular complications assessment in adolescents with 2-to 5-yr duration of type 1 diabetes from 1990 to 2006. Pediatric diabetes. 2011 Dec;12(8):6829.
5. Anderson NK, Nicolay OF. Eating disorders in children and adolescents. In Seminars in Orthodontics 2016 Sep 1 (Vol. 22, No. 3, pp. 234237). WB Saunders.
6. Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, Heller S. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta?analysis. Diabetic medicine. 2013 Feb;30(2):18998.
7. Pinhas-Hamiel O, Hamiel U, Levy-Shraga Y. Eating disorders in adolescents with type 1 diabetes: challenges in diagnosis and treatment. World journal of diabetes. 2015 Apr 15;6(3):517.
8. National Institute for Health and Care Excellence (NICE), 2015. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. London. NICE.
9. National Institute for Health and Social Care Excellence (NICE), 2017. Eating Disorders: Recognition and Treatment. London. NICE.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes