Anorexia nervosa in type 1 diabetics greatly increases mortality

NEW YORK (Reuters Health) – The consequences can be dire for women with type 1 diabetes in whom behaviors associated with anorexia nervosa are not controlled, Danish investigators report.

Dr. Soren Nielsen, of the University of Copenhagen, and colleagues accessed the Danish nationwide psychiatric admission case register to identify 658 girls and women diagnosed with anorexia nervosa between 1970 and 1984. They identified 510 females diagnosed with type 1 diabetes for the two periods from 1970 to 1976 and 1980 to 1984. There were 23 patients who had both conditions concurrently.

During approximately 10 years of follow-up, the mortality rate was 2.2 per 1000 person-years for those with diabetes, while for those with the eating disorder the mortality rate was 7.3 per 1000 person-years. For those with concurrent disorders, the rate was 34.6 per 1000 person-years, the investigators report in the February issue of Diabetes Care.

Based on data from the Danish Central Bureau of Statistics, the standardized mortality ratio for the three groups was 4.06, 8.86, and 14.5 compared with the general population.

The authors report that most of the fatalities in the subjects with diabetes and anorexia disorder occurred during the first 6 to 10 years of observation, which they say is 5 to10 years earlier than observed in patients with type 1 diabetes alone.

"In cases of brittle diabetes, a formal evaluation for eating disorders might be helpful," Dr. Nielsen's group suggests. They also recommend, based on the difficulty of treating these cases, that collaboration between diabetologists and eating disorder specialists is warranted for patients with concurrent disorders.

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