At 5-year follow-up, 98 diabetic girls remained in the study. The average age was 11.8 years at the beginning and 16.5 years at the end of the study.

Colton's group found that 48 of the 98 girls (49.0 percent) still had disturbed eating behavior. Specifically, 43 of the 98 girls reported that they restricted their eating, 6 reported binge-eating episodes, 3 reported self-induced vomiting, and 25 reported intense, excessive exercise for weight control. Another 3 girls reported that they skipped their insulin doses.

A total of 13 girls met the criteria for eating disorders.

The authors note that blood glucose levels were not higher in the subjects with disturbed eating behavior (8.7 percent versus 8.4 percent). However, a trend for higher blood glucose levels was observed among the girls with eating disorders compared with those without (9.1 percent versus 8.5 percent).

The subjects with disturbed eating behavior had a significantly higher average body mass index, at 26.1 versus 23.5 in the other girls. A body mass index (BMI) is the ratio of height to weight used to determine if someone is overweight or underweight. An average weight is between 18.5 and 24.9, and a BMI between 25.0 and 29.9 is overweight. Individuals with a BMI of 30.0 or higher are obese and those with a BMI lower than 18.5 are underweight.

"Eating disturbances early in the study, in the pre-teen years, were very likely to persist over time; 92 percent of girls with eating disturbances detected early in the study continued to report eating disturbances later in their teen years," Colton said in an interview with Reuters Health.

"This study contributes to the growing understanding of the close relationship between physical health and mental health in individuals with diabetes," Colton continued. "In particular, eating disturbances are very common and persistent in girls and women with type 1 diabetes, and can arise in even pre-teen girls," she noted.

These results suggest that screening for eating disturbances in individuals with type 1 diabetes should start in the pre-teen years. "Individuals with diabetes who are struggling with eating disturbances should receive early support and treatment to prevent the development of full-syndrome eating disorders and the medical risks associated with them," Colton advised.

"It is often hard for individuals to tell someone that they have an eating disorder, and so sensitivity to body image issues, body dissatisfaction and eating disturbances, both at home and in the clinic setting, is crucial to helping these individuals seek appropriate help and support in optimizing their health and reaching their full potential," she concluded.

SOURCE: Diabetes Care, November 2007.

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