Worse Metabolic Control and Dynamics of Weight Status in Adolescent Girls Point to Eating Disorders in the First Years after Manifestation of Type 1 Diabetes Mellitus: Findings from the Diabetes Patienten Verlaufsdokumentation Registry - 21/12/18

Doi : 10.1016/j.jpeds.2018.11.037

Thomas Reinehr, PhD ^1,^* , Barbara Dieris ¹, Angela Galler, PhD ², Martin Teufel, PhD ³, Gabriele Berger, PhD ⁴, Rainer Stachow, MD ⁵, Sven Golembowski, MD ⁶, Ute Ohlenschläger, MD ⁷, Martin Holder, MD ⁸, Michael Hummel, MD ⁹, Reinhard W. Holl, PhD ^10,¹¹, Nicole Prinz, PhD ^10,¹¹
¹ Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Witten, Germany
² Charité—Universitätsmedizin Berlin, Berlin, Germany
³ Department of Psychosomatic Medicine and Psychotherapy, LVR-Hospital Essen, University of Duisburg-Essen, Essen,Germany
⁴ Department of Pediatric and Adolescent Medicine, Medical University Vienna, Vienna, Austria
⁵ Fachklinik Sylt for Children and Adolescents, Deutsche Rentenversicherung Nord, Sylt, Germany
⁶ Department of Pediatrics, Sana Hospital Berlin Lichtenberg, Berlin, Germany
⁷ Pediatric Endocrinology and Diabetology, Children University Hospital Frankfurt, Frankfurt, Germany
⁸ Hospital Stuttgart, Olgahospital, Department of Pediatric Endocrinology and—Diabetology, Stuttgart, Germany
⁹ Diabetes Center Rosenheim, Rosenheim, Germany
¹⁰ Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), University of Ulm, Ulm, Germany
¹¹ German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany

^*Reprint requests: Thomas Reinehr, PhD, Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Dr F. Steiner Str. 5, 45711 Datteln, Germany.Department of Pediatric Endocrinology, Diabetes, and Nutrition MedicineVestische Kinder- und JugendklinikUniversity of Witten/HerdeckeDr F. Steiner Str. 5Datteln45711Germany

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 21 December 2018

Abstract

Objective

To assess indications of eating disorders in girls with type 1 diabetes mellitus (T1DM).

Study design

In total 31 556 girls aged >6 months and <23 years of age with T1DM from the Diabetes Patienten Verlaufsdokumentation (DPV) cohort were analyzed including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) girls with bulimia nervosa, 45 (0.14%) girls with binge eating disorder, and 229 (0.73%) girls with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes of glycosylated hemoglobin A1c (HbA1c) levels, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders. Multiple logistic regression analyses were performed.

Results

Eating disorders were significantly associated with late pubertal age, nonusage of pumps, no migration background, increased HbA1c levels, increased frequencies of DKA and severe hypoglycemia, and celiac disease were not related to eating disorders. Significant differences in HbA1c levels, prevalence of DKA and severe hypoglycemia between girls with and without eating disorders were already detectable in the first years after onset of T1DM. A decrease of body mass index (BMI)-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6-14.3] compared with stable BMI-SDS, 6.9-fold [95%CI 3.4-14.1] compared with increase of BMI-SDS).

Conclusions

Poor metabolic control and increased rates of DKA and severe hypoglycemia in the first years after manifestation of T1DM can be hints for eating disorders in girls with T1DM, and weight loss is specific for anorexia nervosa. These clinical features should lead to screening for eating disorders especially at a late pubertal age.

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Keywords : eating disorder, anorexia nervosa, bulimia nervosa, EDNOS, binge eating disorder

Abbreviations : BMI, DSM-IV, EDNOS, HbA1c, T1DM

Plan

Methods

Results

Discussion

Funded by the Federal Ministry of Education and Research within the German Center for Diabetes Research (DZD). Further funding has been received from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115797 (INNODIA) supported by the European Union's Horizon 2020 research and innovation program and “EFPIA,” “JDRF,” and “The Leona M. and Harry B. Helmsley Charitable Trust.” The German Diabetes Association (DDG), the European Foundation for the Study of Diabetes (EFSD), and the German Robert Koch Institute (RKI) provided additional financial support. Sponsors were not involved in data acquisition or analysis. The authors declare no conflicts of interest.