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Type1Diabetes&EatingDisorders:NavigatingtheComplexitiesofProvider-PatientCommunicationQuinnNystrom,M.S.

Speaker,Author&DiabetesAdvocate

NationalDiabetesAmbassador-CenterforChange

WADEConferenceApril26,2019

DisclosuretoParticipants

NoticeofRequirementsforSuccessfulCompletion:Forsuccessfulcompletion,participantsarerequiredtobeinattendanceinthefullactivityandcompletetheprogramevaluationattheconclusionoftheeducationalevent.

PresenterConflictsofInterest/FinancialRelationshipsDisclosures:

Noconflictsexist.

DisclosureofRelevantFinancialRelationshipsandMechanismtoIdentifyandResolveConflictsofInterest:

Noconflictsofinterest.

Non-EndorsementofProducts:AccreditedstatusdoesnotimplyendorsementbyAADE,ANCC,ACPEorCDRofanycommercialproductsdisplayedinconjunctionwiththiseducationalactivity.

Off-labelUse:ParticipantswillbenotifiedbyspeakerstoanyproductusedforapurposeotherthanthatforwhichitwasapprovedbytheFoodandDrugAdministration.

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WILL–AGE5

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AGE13

-Bloodglucosemeter

-Bloodglucoseteststrips

-Ketonestrips

-Lancingdevice

-Lancets

-ContinuousGlucoseMonitor&Sensor

-Alcoholswabs

-Syringes

-Insulinpumpsupplies

-Batteries

-Glucosetablets

-Glucagonkit

-Waterprooftape

-Adhesiveremover

-Friocoolingwallet

-Snacks

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CampNeedlepoint

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NationalYouthAdvocate

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Otherreality…

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WhatisED-DMT1?

�  Thedualdiagnosisofaneatingdisorderandtype1diabetesisoftenreferredtoas“diabulimia,”howeverthisisnotamedicallyrecognizedtermanditisnotanaccuratedescription.

�  “Amongsomeacademics,thenomenclatureeatingdisordersindiabetesmellitustype1(ED-DMT1)isusedtodenotethespectrumofdisturbedeatingbehaviorfoundwithinthisspecificdemographic.”

–JacquelineAllen,BirkbeckUniversity

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Prevalence of Eating Disorders

75%ofAmericanwomenaredissatisfiedwiththeir

appearance.

50%of9yearoldgirlsand80%of10yearoldgirls

havedieted.

Atleast4%ofteenagegirlsandcollege-agewomen

becomeanorexicorbulimic.SteinhausenHC:TheoutcomeofAnorexiaNervosainthe20thcentury.AmJPsychiatry159:1284-1293,2002.AnorexiaNervosaandBulimiaNervosa-Diagnosis&TreatmentGuideforProfessionals.

Eating Disorders +

Diabetes

•  EDbehaviorsseenin8%ofT1DMvs1%ofpeerswithoutDM.

•  IncreasedriskofdisturbedeatingbehavioringirlswithT1DMasyoungas9.

•  32.4%offemaleswithtype1diabeteshavesomeformofdisorderedeatingorweightcontrolbehavior.

•  36%reportedintentionalomissionofinsulin.

•  Strongassociationbetweentype2diabetesandclinicallysignificantbingeeating.

ColtonPetal,Eatingdisordersingirlsandwomenwithtype1diabetes:Alongitudinalstudyofprevalence,onset,remissionandrecurrence.DiabetesCare38:1212-1217,July2015PevelerRC.Type1Diabetes&EatingDisorders,DiabetesCare2005ColtonP.etal,Disturbedeatingbehaviorandeatingdisordersinpreteenandearlyteenagegirlswithtype1diabetes;acase-controlledstudyDiabetesCare27:1654-1659,2004Udoetal.Menopauseandmetabolicsyndromeinobeseindividualswithbingeeatingdisorder.EatBehav2014;15

Why higher risk?

Feelsbetrayedbybodywithdiagnosis

ofdiabetes.Emphasisonfood

anddietaryrestraint.

Societysetting“foodrules”forpeoplewith

diabetes.

Diabetesmanagementfocusesonnumbers.• Patientjudgesselfbeing"good"or"bad"basedoneatingpatternsorbloodglucoselevel.

Beliefthatyou“ateyourwayintodiabetes”.

Weightgain/higherBMI,resultfromintensiveinsulin

therapy.

Temptationfactor• Easyavailabilityofdeliberateinsulinomissiontocontrolweight.

Effectofdiabetesonself-concept,bodyimage,andfamily

interactions.

Familydynamicsinvolvingautonomyandindependenceconcerningdiabetesself-management.

DiabetesSpectrumvolume22,Number3,138-141,160,2009.Mitchell,J.MedicalcomorbidityandmedicalcomplicationsassociatedwithBinge-eatingdisorder.IntJEatDis49:3.