BMJ 2000;320:1563-1566 ( 10 June )

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Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study

Jennifer M Jones, research fellow, ^a Margaret L Lawson, head, ^b Denis Daneman, chief, ^c Marion P Olmsted, director, ^d Gary Rodin, psychiatrist in chief. ^e

^a Department of Psychiatry, University Health Network, Toronto, Ontario, Canada M5G 2CA, ^b Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada K1H 8LI, ^c Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada M5G 2CA, ^d Ambulatory Care for Eating Disorders, University Health Network, ^e Department of Psychiatry, University Health Network

Correspondence to: G Rodin gary.rodin{at}uhn.on.ca

Objective: To determine the prevalence of eating disorders in adolescent females with type 1 diabetes mellitus compared with that in their non-diabetic peers.
Design: Cross sectional case-control led study.
Setting: Diabetes clinics and schools in three Canadian cities.
Subjects: 356 females aged 12-19 with type 1 diabetes and 1098 age matched non-diabetic controls.
Main outcome measure: Eating disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria.
Results: Eating disorders that met DSM-IV criteria were more prevalent in diabetic subjects (36, 10%) than in non-diabetic controls (49, 4%) (odds ratio 2.4, 95% confidence interval 1.5 to 3.7; P<0.001). Subthreshold eating disorders were also more common in those with diabetes (49, 14%) than in controls (84, 8%) (odds ratio 1.9, 95% confidence interval 1.3 to 2.8; P<0.001). Mean haemoglobin A_1c concentration was higher in diabetic subjects with an eating disorder (9.4% (1.8)) than in those without (8.6% (1.6)), P=0.04).
Conclusions: DSM-IV and subthreshold eating disorders are almost twice as common in adolescent females with type 1 diabetes as in their non-diabetic peers. In diabetic subjects, eating disorders are associated with insulin omission for weight loss and impaired metabolic control.

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