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Meta-Analysis
. 2024 May;7(3):e473.
doi: 10.1002/edm2.473.

Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis

Yomna E Dean  1 , Karam R Motawea  1 , Muaaz Aslam  2 , Jose J Loayza Pintado  3 , Helen A O Popoola-Samuel  4 , Mohamed Salam  5 , Prashant Obed Reddy Dundi  6 , Webster Donaldy  7 , Esraa M Aledani  8 , Zaineh Alqiqie  9 , Nazia Sultana  10 , Alaa Ramadan Hussein Mohamed  11 , Amir Elalem  1 , Sidra Tahreem Hashmi Syeda  12 , Mai Saad Mohamed  1 , Mazen W Assal  13 , Nada M Attia  13 , Hanan Hagar  11 , Heba Ahmed Abdelaziz  14 , Anuj Subedi  15 , Areeg Elbahaie  16 , Yusef Hazimeh  17 , Hani Aiash  18
Affiliations
Meta-Analysis

Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis

Yomna E Dean et al. Endocrinol Diabetes Metab. 2024 May.

Abstract

Background: Previous meta-analyses have shown mixed results regarding the association between eating disorders (EDs) and type 1 diabetes mellitus (T1DM). Our paper aimed to analyse different EDs and disordered eating behaviours that may be practiced by patients with T1DM.

Methods: A literature search of PubMed, Scopus and Web of Science was conducted on 17 January 2023, using the key terms "T1DM," "Eating Disorders" and "Bulimia." Only observational controlled studies were included. The Revman software (version 5.4) was used for the analysis.

Results: T1DM was associated with increased risk of ED compared with nondiabetic individuals (RR = 2.47, 95% CI = 1.84-3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18-6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18-1.98, p-value = 0.001). Our analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91-4.12, p-value < 0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27-3.23, p-value = 0.003). Prevalence of insulin omission/misuse was 10.3%; diabetic females demonstrated a significantly higher risk of insulin omission and insulin misuse than diabetic males.

Conclusion: Our study establishes a significant and clear connection between EDs and T1DM, particularly bulimia and binge eating, with T1DM. Moreover, female diabetics are at higher risk of insulin misuse/omission. Early proactive screening is essential and tailored; comprehensive interventions combining diabetes and ED components are recommended for this population, with referral to a specialised psychiatrist.

Keywords: T1DM; anorexia nervosa; bulimia nervosa; eating disorders.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram.
FIGURE 2
FIGURE 2
Eating disorder.
FIGURE 3
FIGURE 3
Anorexia nervosa.
FIGURE 4
FIGURE 4
Bulimia nervosa.
FIGURE 5
FIGURE 5
Bulimia subscale EAT 26.
FIGURE 6
FIGURE 6
Binge eating.
FIGURE 7
FIGURE 7
Dieting subscale EAT 26.
FIGURE 8
FIGURE 8
Bite symptom subscale.
FIGURE 9
FIGURE 9
Bite severity subscale.
FIGURE 10
FIGURE 10
Behaviours 1.
FIGURE 11
FIGURE 11
Behaviours 2.
FIGURE 12
FIGURE 12
Insulin misuse/omission prevalence.
FIGURE 13
FIGURE 13
Insulin omission (females vs. males).
FIGURE 14
FIGURE 14
Insulin misuse (females vs. males).
See this image and copyright information in PMC

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