Eating disorders: a diabetes perspective. Part 1

Abstract

The COVID-19 pandemic had a considerable impact on mental and physical health, exacerbating eating disorders (EDs), especially in people with diabetes mellitus (DM). DM, in any of its types, presents specific challenges in managing food intake, blood glucose levels, and pharmacological treatment, which can contribute to the development or worsening of maladaptive eating behaviors. In people with type 1 DM, bulimia nervosa, anorexia nervosa, and food avoidance/restriction are the most common eating disorders, while in type 2 DM, binge eating episodes without compensatory behaviors are more prevalent.

With the aim of synthesizing recent evidence on the intersection between DM and EDs, clarifying diagnostic definitions (DSM-5 as the main reference), clinical terminology, and considerations for interdisciplinary assessment and intervention, a focused narrative review of indexed literature and normative documents was conducted. Relevant reviews, guidelines, and original articles on diabetes mellitus (DM) and EDs published in recent years were prioritized.

This article aims to examine the relationship between EDs and DM, highlighting how eating disorders can complicate disease management, increase the risk of complications, and create a vicious cycle of mismanagement. A distinction is proposed between disordered eating behaviors, which are more common but not necessarily clinically significant, and diagnosable EDs that require specialized care. Furthermore, predisposing, precipitating, and maintaining factors that influence the development of these disorders are discussed, along with the importance of early and coordinated intervention that includes both medical treatment for DM and psychological support. Recommended interventions include body image education, cognitive behavioral therapy, and family support, with an interdisciplinary approach to improve well-being and diabetes control in these individuals.