A case series of disordered eating in type 1 diabetes adult patients: “diabulimia” and beyond

Introduction: Type 1 diabetes (T1D) is a chronic disease with a great impact on the quality of life, and eating behavior and habits. Feeding and eating disorders (FED) [1] can occur more frequently in patients with T1D than in the general population [2–5]. The most studied condition, especially in young women, is “diabulimia’’, which refers to a pattern characterized by concern about body shape and weight and by insulin restriction (reduction or omission of prescribed doses) with the purpose of controlling body weight [6–10]. However, disordered eating (DE) in T1D often does not meet the formal criteria of FED, leading to an underdiagnosis [4, 11, 12]. Aim of the study: Describing two different phenotypes of adult patients affected by T1D and DE/FED. Materials and methods: Three female patients (AF, AM, MD) with T1D, aged between 42 and 66, were addressed to the Integrated Experimental Service for Eating Disorders at Sapienza University of Rome, for suspected FED. Anthropometric, nutritional and clinical parameters were examined (Table 1); the patients were asked to fill out a 3-day food diary and a diary of glycaemia and insulin doses. The presence of FED was evaluated in a clinical interview through EDE 17.0D (Table 2). Questionnaires have been administered to assess eating behavior and other psychological characteristics (Table 3). Results: All three patients presented a considerably high level of HbA1c (Table 1) and clinical complications. AF presented insulin misuse, and concern about body shape, EDE results and clinical observation were consistent with “diabulimia”. AM and MD, thus not reporting symptoms consistent with any FED diagnosis, presented restrictive eating, eating concern, psychological distress (MD) and difficulties with insulin doses and carb counting (AM and MD), which appeared to be secondary to concern about health. Discussion and conclusions: Patients with T1D can present different forms of DE secondary in some cases to shape and weight concerns and in some other cases to health concerns. Eating behavior and psychological status should be evaluated in T1D to assess the presence of FED or DE to avoid or minimize the impact on health status.