Classification of type 1 diabetic females with bulimia nervosa into subgroups according to purging behavior.
OBJECTIVE
To classify type 1 diabetic females with bulimia nervosa (BN) by type of inappropriate compensatory behavior in order to prevent weight gain (ICB) and to investigate the group differences.


METHODS
Type 1 diabetic females with BN, diagnosed by structured diagnostic interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) criteria, were classified by type of ICB as follows: 1) only severe insulin omission as an ICB (BN-I) (n = 22), 2) both severe insulin omission and self-induced vomiting and/or laxative abuse (BN-IP) (n = 22), or 3) no insulin omission but another ICB (BN-NI) (n = 11). The clinical characteristics of these three groups and a binge-eating disorder (BED) group (n = 24) were compared.


RESULTS
The BN-IP and BN-I groups had the highest HbA(1c) levels. The BN-IP group had the highest rates of diabetic neuropathy, retinopathy, and nephropathy. The BN-NI group had the second highest rates of neuropathy and retinopathy. The BN-IP group had the highest frequencies of diabetes- and ketoacidosis-related hospital admissions, and the BN-I group had the second highest frequencies. The BN-NI group showed the highest scores on psychological tests related to depression, anxiety, eating disorder psychopathology, and perfectionism. The BN-NI group had the highest rate of history of visits to a psychiatrist, and the BN-IP group had the second highest history.


CONCLUSIONS
Type 1 diabetic females with BN seem not to be homogenous and can be classified into three distinctive subgroups by type of ICB. Individuals with BN-IP had the most severe problems with both medical and psychological/behavioral aspects. Individuals with BN-NI manifested the highest psychological distress. The BN-I group had comparatively mild distress despite having the poorest metabolic control. Each BN group manifested more severe pathology than the BED group.
Department of Psychosomatic Medicine, Graduate School of Medicine, Kyushu University, Fukuoka, Japan. takii@cephal.med.kyushu-u.ac.jp
Masato
M
Takii
Yasuko
Y
Uchigata
Takehiro
T
Nozaki
Hiroaki
H
Nishikata
Keisuke
K
Kawai
Gen
G
Komaki
Yasuhiko
Y
Iwamoto
Chiharu
C
Kubok
D000293:Adolescent; D000328:Adult; D002032:Bulimia / Q000145:classification* / Q000523:psychology*; D002400:Cathartics / Q000008:administration & dosage; D003922:Diabetes Mellitus, Type 1 / Q000145:classification* / Q000188:drug therapy / Q000523:psychology*; D003928:Diabetic Nephropathies / Q000145:classification / Q000188:drug therapy / Q000523:psychology; D003929:Diabetic Neuropathies / Q000145:classification / Q000188:drug therapy / Q000523:psychology; D003930:Diabetic Retinopathy / Q000145:classification / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D010349:Patient Compliance
D002400:Cathartics; D007004:Hypoglycemic Agents; D007328:Insulin