胰岛素依赖型糖尿病年轻女性的饮食行为紊乱与微血管并发症

Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus.

作者信息

Rydall A C, Rodin G M, Olmsted M P, Devenyi R G, Daneman D

机构信息

Toronto Hospital, ON, Canada.

出版信息

N Engl J Med. 1997 Jun 26;336(26):1849-54. doi: 10.1056/NEJM199706263362601.

DOI:10.1056/NEJM199706263362601

PMID:9197212

Abstract

BACKGROUND

Insulin-dependent diabetes mellitus (IDDM) and eating disorders are relatively common among young women in North America. Their coexistence could lead to poor metabolic control and an increased risk of the microvascular complications of IDDM.

METHODS

We studied 91 young women with IDDM at base line and four to five years later to determine the prevalence and persistence of disordered eating behavior (on the basis of self-reported eating and weight-loss practices, including the intentional omission or underdosing of insulin to control weight) and the association of such eating disorders with metabolic control, diabetic retinopathy, and urinary albumin excretion. At base line, the mean age of the young women was 15+/-2 years and the duration of diabetes was 7+/-4 years.

RESULTS

At base line, 26 of 91 young women (29 percent) had highly or moderately disordered eating behavior, which persisted in 16 (18 percent) and improved in 10 (11 percent). Of the 65 women with normal eating behavior at base line (71 percent), 14 (15 percent) had disordered eating at follow-up. Omission or underdosing of insulin lose weight was reported by 12 of 88 young women (14 percent) at base line and 30 (34 percent) at follow-up (P=0.003). At base line, the mean (+/-SD) hemoglobin A(1c) value was higher in the group with highly disordered eating behavior (11.1+/-1.2 percent) than in the groups whose eating behavior was moderately disordered (8.9+/-1.7 percent) or nondisordered (8.7+/-1.6 percent, P<0.001). Disordered eating at base line was associated with retinopathy four years later (P=0.004), when 86 percent of the young women with highly disordered eating behavior, 43 percent of those with moderately disordered eating behavior, and 24 percent of those with nondisordered eating behavior had retinopathy.

CONCLUSIONS

Disordered eating behavior is common and persistent in young women with IDDM and is associated with impaired metabolic control and a higher risk of diabetic retinopathy.

摘要

背景

胰岛素依赖型糖尿病（IDDM）和饮食失调在北美年轻女性中相对常见。它们的共存可能导致代谢控制不佳以及IDDM微血管并发症风险增加。

方法

我们对91名患有IDDM的年轻女性进行了基线研究，并在四到五年后进行随访，以确定饮食紊乱行为的患病率和持续性（基于自我报告的饮食和减肥习惯，包括故意不注射胰岛素或减少胰岛素剂量以控制体重），以及此类饮食失调与代谢控制、糖尿病视网膜病变和尿白蛋白排泄之间的关联。基线时，这些年轻女性的平均年龄为15±2岁，糖尿病病程为7±4年。

结果

基线时，91名年轻女性中有26名（29%）存在高度或中度饮食紊乱行为，其中16名（18%）持续存在，10名（11%）有所改善。在基线时饮食行为正常的65名女性（71%）中，14名（15%）在随访时出现饮食紊乱。88名年轻女性中，有12名（14%）在基线时报告通过不注射胰岛素或减少胰岛素剂量来减肥，而在随访时有30名（34%）报告这样做（P = 0.003）。基线时，饮食行为高度紊乱组的平均（±标准差）糖化血红蛋白A1c值（11.1±1.2%）高于饮食行为中度紊乱组（8.9±1.7%）或无紊乱组（8.7±1.6%，P<0.001）。基线时的饮食紊乱与四年后的视网膜病变相关（P = 0.004），此时饮食行为高度紊乱的年轻女性中有86%、中度紊乱的有43%、无紊乱的有24%患有视网膜病变。