One in four patients with insulin-dependent diabetes aged 16 years and older also exhibit some kind of eating disorder symptoms, according to a recent meta-analysis conducted at the University of Eastern Finland. In addition to typical eating disorder symptoms, such as binge eating and food restriction, insulin-dependent diabetes is also associated with insulin omission, i.e., a unique form of disordered eating where insulin doses are intentionally restricted or skipped entirely due to fears of weight gain.

“Intentional skipping or restriction of insulin doses will lead to weight loss, but this also maintains high blood glucose, throwing the management of diabetes off balance,” Doctoral Researcher Pia Niemelä of the University of Eastern Finland says.

According to the meta-analysis, one in five patients reported intentional insulin omission.

Published in Eating Behaviors, the meta-analysis compiled findings from 45 previous studies. The data included a total of 11,592 individuals with insulin-dependent diabetes, of whom 2,521 exhibited eating disorder symptoms.

Eating disorder symptoms were more common in women than in men, which is an observation that has previously been made in young people as well. Age, however, was not a significant factor, as eating disorders occurred regardless of age group.

“Eating disorder symptoms are often thought to affect adolescents and young adults. However, our meta-analysis shows that adults, too, suffer from eating disorder symptoms, which is why it is important to learn to identify patients with eating disorders. Here in Finland, for example, we currently don’t have a care pathway for patients who have both diabetes and eating disorders. Understanding the clinical picture and its prevalence is the first step in developing treatment and care pathways,” Niemelä says.

Diabetics with eating disorder symptoms have a higher risk of comorbidities and complications associated with diabetes. Eating disorder symptoms are screened using various surveys, including the most commonly used DEPS-R, which in the current meta-analysis was positive in 27 per cent of the subjects.

Research article:

Niemelä PE, Leppänen HA, Voutilainen A, Möykkynen EM, Virtanen KA, Ruusunen AA, Rintamäki RM. Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis. Eat Behav. 2024 Feb 28;53:101863. doi: https://doi.org/10.1016/j.eatbeh.2024.101863