title: Clinical characteristics and outcome of 467 patients with a clinically recognized eating disorder identified among 52,215 patients with type 1 diabetes: a multicenter german/austrian study.
abstract: OBJECTIVE
  To compare clinical characteristics and outcome of type 1 diabetes mellitus (T1DM) between patients with and without a clinically recognized eating disorder (ED).
  
  
  METHODS
  A total of 52,215 T1DM patients aged 8 to <30 years from the prospective diabetes data acquisition system DPV were analyzed. A total of 467 patients had an additional diagnosis of ED according to DSM-IV criteria (anorexia nervosa [AN], n = 141 [female: 94.3%]; bulimia nervosa [BN], n = 62 [90.3%]; and EDs not otherwise specified, including binge-eating disorder [EDNOS], n = 264 [74.2%]). Groups were compared using multivariable regression. Cox proportional hazard ratios were calculated for the association between ED and retinopathy.
  
  
  RESULTS
  After adjustment for age, sex, and duration of diabetes, patients with ED revealed higher HbA1c (no ED vs. AN, BN, or EDNOS, respectively: 8.29 ± 0.01% [67.1 ± 0.1 mmol/mol] vs. 8.61 ± 0.15% [70.6 ± 1.6 mmol/mol], 9.11 ± 0.23% [76.1 ± 2.5 mmol/mol], or 9.00 ± 0.11% [74.9 ± 1.2 mmol/mol]) and a higher rate of pathological insulin injection sites (48.4 vs. 64.3, 64.1, or 62.1%). Furthermore, ketoacidosis (5.7 ± 0.1 vs. 12.1 ± 2.1, 18.0 ± 4.1, or 12.9 ± 1.6 events per 100 person-years) and hospitalization (54.9 ± 0.3 vs. 89.3 ± 6.0, 132.0 ± 12.7, or 91.0 ± 4.4 per 100 person-years) were more common, and duration of hospital stay was longer (4.81 ± 0.01 vs. 11.31 ± 0.21, 18.05 ± 0.48, or 8.44 ± 0.13 days per year). All P values were <0.05. Patients with BN and EDNOS had a 2.5-fold (95% CI 1.3-4.8) and a 1.4-fold (0.8-2.3) higher risk for retinopathy, whereas AN patients had no increased risk (0.9 [95% CI 0.4-2.3]).
  
  
  CONCLUSIONS
  Diabetes health care professionals should be aware of comorbid EDs in pediatric/young-adult T1DM patients. An ED diagnosis is associated with worse metabolic control and higher rates of diabetes complications.
authors.affiliation: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany nicole.scheuing@uni-ulm.de.
authors.forename: Nicole
authors.initials: N
authors.lastname: Scheuing
authors.affiliation: Pediatric Clinic, Olgahospital Stuttgart, Stuttgart, Germany.
authors.forename: Béla
authors.initials: B
authors.lastname: Bartus
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Berger
authors.affiliation: Hospital for Children and Adolescents, Sana Hospital Berlin Lindenhof, Berlin, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Haberland
authors.affiliation: Department of Public Health, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyInstitute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
authors.affiliation: Diabetes Centre, Christian Association of Youth Villages Berchtesgaden Health-Education-Employment, Berchtesgaden, Germany.
authors.forename: Burkhild
authors.initials: B
authors.lastname: Knauth
authors.affiliation: Diabetes Centre Mergentheim, Bad Mergentheim, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nellen-Hellmuth
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.affiliation: Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
authors.affiliation: Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D001317:Austria / Q000453:epidemiology; D056912:Binge-Eating Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D005006:Ethnicity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult