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Original Article
Volume 336:1849-1854 June 26, 1997 Number 26
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Disordered Eating Behavior and Microvascular Complications in Young Women with Insulin-Dependent Diabetes Mellitus
Anne C. Rydall, M.Sc., Gary M. Rodin, M.D., Marion P. Olmsted, Ph.D., Robert G. Devenyi, M.D., and Denis Daneman, M.B., B.Ch.

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ABSTRACT

Background Insulin-dependent diabetes mellitus (IDDM) and eating disorders are relatively common among young women in North America. Their coexistence could lead to poor metabolic control and an increased risk of the microvascular complications of IDDM.

Methods We studied 91 young women with IDDM at base line and four to five years later to determine the prevalence and persistence of disordered eating behavior (on the basis of self-reported eating and weight-loss practices, including the intentional omission or underdosing of insulin to control weight) and the association of such eating disorders with metabolic control, diabetic retinopathy, and urinary albumin excretion. At base line, the mean age of the young women was 15±2 years and the duration of diabetes was 7±4 years.

Results At base line, 26 of 91 young women (29 percent) had highly or moderately disordered eating behavior, which persisted in 16 (18 percent) and improved in 10 (11 percent). Of the 65 women with normal eating behavior at base line (71 percent), 14 (15 percent) had disordered eating at follow-up. Omission or underdosing of insulin to lose weight was reported by 12 of 88 young women (14 percent) at base line and 30 (34 percent) at follow-up (P = 0.003). At base line, the mean (±SD) hemoglobin A1c value was higher in the group with highly disordered eating behavior (11.1±1.2 percent) than in the groups whose eating behavior was moderately disordered (8.9±1.7 percent) or nondisordered (8.7±1.6 percent, P<0.001). Disordered eating at base line was associated with retinopathy four years later (P = 0.004), when 86 percent of the young women with highly disordered eating behavior, 43 percent of those with moderately disordered eating behavior, and 24 percent of those with nondisordered eating behavior had retinopathy.

Conclusions Disordered eating behavior is common and persistent in young women with IDDM and is associated with impaired metabolic control and a higher risk of diabetic retinopathy.


Source Information

From Toronto Hospital (A.C.R., G.M.R., M.P.O., R.G.D.), the Hospital for Sick Children (D.D.), and the University of Toronto (G.M.R., M.P.O., R.G.D., D.D.) — all in Toronto. Presented in part at the 55th Annual Meeting and Scientific Sessions of the American Diabetes Association, Atlanta, June 12, 1995, and the 53rd Annual Meeting of the American Psychosomatic Society, New Orleans, March 4, 1995.

Address reprint requests to Dr. Rodin at the Department of Psychiatry, Eaton Wing 8-222, Toronto Hospital, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada.

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