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World J Diabetes. Apr 15, 2015; 6(3): 517-526
Published online Apr 15, 2015. doi: 10.4239/wjd.v6.i3.517
Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment
Orit Pinhas-Hamiel, Uri Hamiel, Yael Levy-Shraga
Orit Pinhas-Hamiel, Uri Hamiel, Yael Levy-Shraga, Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel
Orit Pinhas-Hamiel, Uri Hamiel, Yael Levy-Shraga, Sackler School of Medicine, Tel-Aviv University, Juvenile Diabetes Center, Maccabi Health Care Services, Ramat-Gan 52621, Israel
Author contributions: Pinhas-Hamiel O, Hamiel U and Levy-Shraga Y performed literature review, wrote the paper, and conceived the three level models and created the graphs.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Orit Pinhas-Hamiel, Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel. orithami@sheba.health.gov.il
Telephone: +972-3-5305015 Fax: +972-3-5305055
Received: August 27, 2014
Peer-review started: August 28, 2014
First decision: November 27, 2014
Revised: December 9, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 15, 2015
Processing time: 236 Days and 8.2 Hours
Abstract

Eating disorders (ED) are characterized by a persistent disturbance of eating that impairs health or psychosocial functioning. They are associated with increased rates of medical complications and mortality. Insulin omission is a unique purging behavior available to individuals with type 1 diabetes mellitus (T1DM). The standard treatment regimen for T1DM requires a major focus on food and eating patterns. Moreover, intensive insulin therapy is associated with increasing body weight. These factors, combined with the psychological burden of chronic disease management and depression, may contribute to ED. The comorbidity of ED in T1DM patients is associated with poorer glycemic control and consequently higher rates of diabetes complications. Early recognition and adequate treatment of ED in T1DM is essential.

Keywords: Type 1 diabetes, Eating disorders, Insulin omission

Core tip: Intentional insulin omission for the purpose of preventing weight gain is a unique behavior available to individuals with type 1 diabetes mellitus (T1DM). It is classified as either an inappropriate compensatory feature of bulimia nervosa or as a purging disorder component of other specified feeding or eating disorder (ED). Its prevalence increases with age, affecting up to 40% of young adult females with T1DM. The comorbid of ED in T1DM patients is associated with higher rates of short and long-term diabetes complications. A high index of suspicion is needed since ED behaviors are often well hidden and denied. Treatment involves a complex interplay of psychosocial, dietary and medical aspects and requires a multidisciplinary team.