Nissim Rinat, Rodin Gary, Daneman Denis, Rydall Anne, Colton Patricia, Maharaj Sherry, Jones Jennifer
Department of Psychiatry, General Hospital of Toronto, Ontario District, Canada.
Harefuah. 2002 Oct;141(10):902-7, 929.
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.
符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的饮食失调症，尤其是神经性贪食症和未特定的饮食失调症（EDNOS），在1型糖尿病（DM）青少年女性中的发病率是其非糖尿病同龄人中的两倍多。阈下饮食失调症在该群体中的患病率尤其高，在14%的糖尿病女孩中可能会出现。胰岛素漏用是患有糖尿病和饮食失调症女孩中常见的减肥行为。胰岛素漏用和暴饮暴食不可避免地会导致高血糖率上升以及与糖尿病相关的长期医疗并发症风险增加，包括视网膜病变和肾病。与糖尿病治疗相关的体重增加和饮食限制，以及为促进减肥而容易获得的胰岛素漏用情况，很可能是导致饮食失调症患病率上升的原因。建议在糖尿病诊所环境中对饮食失调症保持高度怀疑指数，以便在紊乱的饮食态度和行为发展为临床饮食失调症之前尽早识别。基于诊所的心理教育项目可能对预防或早期干预有效。严重的饮食失调症需要更强化的干预措施，要根据糖尿病的情况进行调整。
