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Although the causes of eating disorders remain unclear, epidemiological evidence suggests that peripubertal changes in body shape and weight predispose young women to develop unhealthy eating attitudes. A psychiatric diagnosis of an eating disorder can be made in up to 10% of young women with insulin-dependent diabetes mellitus (type 1 diabetes). Eating disorders, anorexia nervosa and bulimia nervosa, pose a particularly serious risk to health in young diabetic people. Several features associated with type 1 diabetes and its treatment, such as weight gain, dietary restraint and food preoccupation, may predispose young diabetic women to develop a clinical or subclinical eating disorder. The coexistence of these conditions could lead to poor metabolic control and an increased risk of microvascular complications.
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PMID:Eating disorders in adolescents with type 1 diabetes mellitus. 1043 48

As part of a multicentre study on the comorbidity of diabetes mellitus and eating disorders, the following paper compares the psychological features of diabetic patients with and without an eating disorder. In a sample of 663 diabetic patients (type 1: n = 341 type 2: n = 322), eating disorder related variables, self-esteem, body acceptance and emotional distress, especially depression in diabetic patients with and without an eating disorder, were compared. A possible relationship to diabetic control was investigated. Type 2 diabetics revealed more pronounced psychopathology in comparison to type 1 diabetics. According to our assumption, diabetic patients with an eating disorder and diabetic patients who deliberately reduced insulin in order to loose weight (insulin purging) revealed a much more severe psychopathology compared to diabetics without an eating disorder. The type of diabetes was of no importance. With the exception of the variable body and figure satisfaction in the sample of type 1 diabetes and the variable self-acceptance in the sample of type 2 diabetes, no relationship to diabetic control could be found.
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PMID:[Comorbidity of diabetes mellitus and eating disorders. A comparison of psychological features of eating disordered and non-eating disordered patients with diabetes mellitus]. 1078 Jan 57

In Switzerland, 6% of men and 5% of women are obese (BMI > 30); 33% of men and 17% of women are overweight (BMI 25-30). Both genetic and environmental factors are responsible for obesity. There is an increased risk of C-V disease, diabetes and steato-hepatitis in abdominal obesity (abdominal circumference > 102 cm for men and > 88 cm for women). There is also an increased level of cortisol, which could be due to a difficulty to cope with psycho-social stress. Leptine and different hormones play a role in fat storage. Menopause and pregnancy are moderate risk factors for obesity. Weight gain may also result from different drugs, smoking cessation and stress. Eating disorders such as boulimia and binge eating must be diagnosed and treated. Beneficial health effect of weight loss is analysed.
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PMID:[Ten questions on the causes and consequences of obesity: stress hormones]. 1123 10

The cultural drive to be thin can lead to eating disorders in many women and girls. In adolescent females with diabetes, the increased focus on eating and the weight gain associated with good glycemic control likely increase their susceptibility to abnormal eating. It is clear that nonspecified and subthreshold eating disorders, and possibly bulimia and anorexia, are more common in this group of patients. Good nutritional counseling to help patients avoid weight gain and family counseling to improve communication between patients and their families may help decrease this risk. Intentional insulin omission is a frequent means of preventing weight gain or increasing weight loss in adolescent females with type 1 diabetes. Eating disorders should be suspected in patients with recurrent diabetic ketoacidosis or poor glycemic control that is resistant to attempts at improvement. Treatment includes decreasing dietary restraint, promoting healthy eating, and either psychiatric counseling or psychologic intervention, or both.
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PMID:Eating disorders in adolescents with type 1 diabetes. A closer look at a complicated condition. 1131 70

Although prevalence estimates vary in women with type 1 diabetes mellitus, studies suggest the occurrence of eating disorders is comparable between women with and without diabetes mellitus. A new study examined the association between eating disorders and type 1 diabetes mellitus in 12-19-year-old females with diabetes for at least 1 year. Subjects with diabetes were 2.4 times more likely than controls (without diabetes) to have a clinical eating disorder and 1.9 times more likely to have a subthreshold eating disorder. Moreover, mean glycosylated hemoglobin was higher in subjects with diabetes who had an eating disorder (9.4%) compared with those with diabetes without an eating disorder (8.6%).
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PMID:Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered? 1144 95

The coexistence of type 1 diabetes mellitus and disordered eating is associated with poor metabolic control, poor adherence to diabetes treatment regimens, and increased risk of long-term diabetic complications. This study assessed whether a six-session group psychoeducation program would improve metabolic control, diabetes treatment adherence, eating disorder symptomatology, and general psychopathology in women with coexisting type 1 diabetes and subclinical disordered eating. Fourteen women were assigned to the treatment group (n=8) or wait-list control group (n=6). Measurements were taken at baseline, post-intervention, and one month post-intervention. There were no significant differences in how the treatment group and wait-list control group changed over time. Between the first and second measurements, both groups demonstrated significant improvements in depression and general emotional distress. The results suggest that a six-session group psychoeducation program is no more effective than a wait-list control group for treating subclinical disordered eating in women with type 1 diabetes. Further research is required to determine the most effective treatment for this population.
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PMID:Effectiveness of a group psychoeducation program for the treatment of subclinical disordered eating in women with type 1 diabetes. 1174 60

Adolescents with insulin dependent diabetes mellitus (IDDM) who choose to be vegetarian have complex nutritional needs because of their continued physical growth and development, their participation in strenuous activities, and their need to consume sufficient carbohydrates to match their insulin doses. Since diet control is a cornerstone of diabetes management, the adolescent who chooses a vegetarian diet may cause their parents needless anxiety. Nurses working with these adolescents can provide support and guidance and liaison with the endocrinologist, nutritionist or dietitian, and diabetic educator. Although adolescent diabetic vegetarians have not been studied extensively as a population, facts about nutrition and diabetes can be used to assist in meal planning. A complete growth and nutritional assessment must be done to search for any problem areas. If protein dense flesh food is eliminated and a largely carbohydrate diet is consumed, there are additional areas of concern in regulating insulin needs. Blood glucose should be monitored very carefully during diet changes. Vegetarian girls with diabetes also should be carefully monitored for the adequacy of their diet because they may be at risk of developing an eating disorder.
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PMID:Vegetarian diet planning for adolescents with diabetes. 1202 41

Eating disorders that meet DSM-IV criteria, especially bulimia nervosa and EDNOS are more than twice as common in adolescent girls with Type 1 Diabetes (DM) than in their nondiabetic peers. The prevalence of subthreshold eating disorders is especially high in this group and may be found in 14% of girls with DM. Insulin omission is a common weight loss behavior in girls with DM and eating disorders. Insulin omission and binge eating inevitably contribute to the increased rate of hyperglycemia and increased risk of long-term diabetes related medical complications, including retinopathy and nephropathy. The weight gain and dietary restrictions associated with diabetes treatment and the ready availability of insulin omission to promote weight loss are most likely responsible for this increased prevalence of eating disorders. A high index of suspicion for eating disorders is recommended in the diabetes clinic setting to enable early identification of disordered eating attitudes and behavior before they progress to clinical eating disorders. Clinic-based psychoeducational programs may be effective for prevention or early intervention. Severe eating disorders require more intensive intervention, tailored to address the DM context.
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PMID:[Eating disturbances in adolescent girls with type 1 diabetes mellitus]. 1242 May 98

The aim of the article is to investigate the relationship between disordered eating, particularly binge eating, and Type 2 diabetes in women. Subjects included 215 women with Type 2 diabetes (mean age: 58.9 years, mean body mass index (BMI)=33.5 kg/m(2)). Measurements included a structured clinical interview for disordered eating (Eating Disorder Examination, EDE), self-report measures of psychological functioning, glycosylated haemoglobin A1c, BMI. A total of 20.9% of women was binge eating regularly. Binge eating was associated with poorer well being, earlier age of diagnosis, poorer self-efficacy for diet and exercise self-management, and higher BMI. Binge eating frequency predicted blood glucose control after controlling for BMI and exercise level. A history of binge eating independently predicted age of diagnosis of diabetes. Binge eating is relatively common in women with Type 2 diabetes. The relationship between binge eating severity and diabetic control is not explained by overweight. Binge eating may be an independent risk factor for Type 2 diabetes.
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PMID:Disordered eating behaviours in women with Type 2 diabetes mellitus. 1500 Oct 45

We report a 32-year-old female with eating disorder whose body weight was only 20 kg. She was admitted to the hospital with severe low nutrition, low proteinemia, liver dysfunction, hypokalemia and hypoglycemia. On the third hospital day, she had a high fever and Campylobacter fetus subsp. fetus (C. fetus) was isolated from the blood. After treatment with meropenem (1 g/day) intravenous drip injection, her condition improved. C. fetus sepsis is not common disease in Japan. A review of 37 cases of this disease in Japan revealed that the age range of adult patients was 20 to 60 years old. The male-to-female ratio was 4.6 to 1.0. Seventy-eight percent of the patients had underlying diseases which were composed of 11 patients with liver disease, 6 patients with blood dyscrasia and some with diabetes mellitus, heart disease, other malignant tumor and collagen disease. There was no case with eating disorder. All apparent sources of infection in Japan originate from eating raw food. Gastrointestinal symptoms were observed in only 16% of the patients. Recent recommendations for the treatment of C. fetus sepsis are to use gentamicin, imipenem and meropenem. Some strains of C. fetus have resistance to erythromycin, ciprofloxacin. The mortality of this infection is 14% in Japan.
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PMID:[Campylobacter fetus subsp. fetus sepsis: a case report and review of the literatures in Japan]. 1510 97


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