Eating disorders are more common in individuals with type 1 diabetes than in the general population. Although limited research has been conducted in this area, existing evidence shows that these conditions significantly affect the physical and emotional health of individuals with diabetes and are associated with impaired metabolic control and a high risk of medical complications, including higher mortality rates. New nomenclature was recommended at an international focus group held in Minneapolis, Minn., in September 2008. Composed of individuals with interest and expertise in eating disorders among individuals with diabetes, the group recommended that the term ED-DMT1 be used to designate those with an eating disorder and type 1 diabetes and ED-DMT2 be used for those with an eating disorder and type 2 diabetes. This article provides an overview of clinical features, consequences, and pathways of risk associated with ED-DMT1.

The medical risks associated with eating disorders in diabetes are significant. Clinicians working with patients who are at risk for eating disorders should be cognizant of patterns that might indicate the presence of disturbed eating behaviors in their patients. This article discusses the warning signs, screening tools, and diagnostic criteria associated with eating disorders in type 1 diabetes.

Disturbed eating behaviors are common in adolescent girls and young women; however, these behaviors are significantly more common in those with type 1 diabetes than in the general population. Long-term treatment of patients with eating disorders and type 1 diabetes (ED-DMT1) often occurs in outpatient settings. This article reviews the clinical issues and strategies relevant to the outpatient treatment of ED-DMT1.

Individuals with both eating disorders and type 1 diabetes (ED-DMT1) who are medically or psychiatrically unstable may require inpatient treatment to stabilize glucose control and establish regular eating patterns. The purpose of this article is to review the clinical issues and strategies relevant to the treatment of ED-DMT1 within the inpatient setting.

Registered dietitians and nurses who specialize in diabetes education are often in the position of identifying patients at risk for an eating disorder or those who have an undiagnosed eating disorder. Diabetes educators will find it helpful to establish relationships and communication with eating disorder specialists in their area to prepare a plan for caring for these individuals.

Research design and methods. In 2006, the National Diabetes Education Program conducted a telephone survey of the U.S. population ≥ 45 years of age. The sample size for this study was 1,389 people who reported no previous diagnosis of diabetes. Logistic regression analyses were conducted to identify independent variables associated with the perception of risk for diabetes among people without a diagnosis of diabetes.

Results. More than half (55%) of the U.S. population aged ≥ 45 years had one or more risk factors for diabetes, yet only about one-fourth (23%) felt they were at risk for the disease. In the multivariate analyses, feeling at risk for diabetes is associated with a younger age (45-64 vs. ≥ 65 years; odds ratio[OR] 2.50; 95% CI 1.56-4.01); being of a race or ethnicity other than white, African American, or Hispanic/Latino compared to non-Hispanic whites (OR 2.26; 95% CI 1.19-4.31); being obese (OR 3.23; 95% CI 1.90-5.50); having a family history of diabetes (OR 5.53; 95% CI 3.55-8.60); and having had a diagnosis of pre-diabetes (OR 5.80; 95% CI 3.31-10.16). African Americans are significantly less likely to feel at risk for diabetes compared to non-Hispanic whites (OR 0.53; 95% CI 0.29-0.96).

Conclusions. Based on these findings, special attention needs to be placed on reaching older adults and African Americans who report significantly lower levels of self-perceived risk of diabetes. An emphasis on increased susceptibility due to a family history of diabetes, obesity, and a diagnosis of pre-diabetes appear to be meaningful cues to increasing perceived risk.

Research design and methods. Clinical and community-based programs participating in the RWJF-funded Diabetes Initiative implemented comprehensive models for self-management, including supports to increase physical activity. A cohort of 622 largely lower-income and ethnic minority program participants (72% female, 85% overweight or obese) completed telephone surveys assessing self-reported physical activity levels at two times that were about 8 months apart.

Results. Approximately 70% of participants who reported being inactive at Time 1 reported at least some physical activity at Time 2. Approximately 29% of participants who reported insufficient activity at Time 1 increased their activity enough to meet current public health guidelines at Time 2, whereas 28% of those who were sufficiently active no longer met the guidelines. Sufficient physical activity was associated with greater intervention intensity; being male, younger, and speaking English; and having greater self-efficacy, a lower BMI, and a health care provider who assisted in finding physical activity resources.

Conclusions. Personal, behavioral, and program factors were related to physical activity levels among participants in these comprehensive self-management programs.