June 25, 1997 ... Weight preoccupation and the drive to be thin are placing many young teenaged girls with diabetes at risk for serious complications associated with the disease.
In a study published today in the New England Journal of Medicine, Toronto researchers found that:
"Many young women with diabetes are faced with a double-edged sword," says Dr. Gary Rodin, principal investigator of the study and Head of Psychiatry at The Toronto Hospital. "Not only does conventional diabetes treatment encourage dietary restriction, but the initiation of insulin may lead to as much as 10 pounds of weight gain. At the same time, young women with diabetes are confronted with all of the cultural pressures to be thin that affect other teenaged girls. The dietary restriction and weight gain related to their diabetes may set into motion a cycle of binge eating, dieting and deliberate insulin omission particularly in those who are already preoccupied with their weight and shape. This cycle increases blood sugars and, when it persists, the risk of eye complications," adds Dr. Rodin, who is also Professor, Department of Psychiatry, University of Toronto.
Adds Anne Rydall, the research co-ordinator for the research team, "A lot of emphasis is placed on diet and food in the management of diabetes in young teens. A less rigid approach with an emphasis on normalizing the diet may actually lead to better control of blood sugars."
"A more relaxed approach to the management of diabetes may be necessary to interrupt the cycle of dieting and binge eating," says Dr. Denis Daneman, Professor of Pediatrics, University of Toronto and Head of Pediatric Endocrinology at the Hospital for Sick Children and a co-investigator in the study. Dr. Daneman suggests that endocrinologists and family physicians treating young women with diabetes should consider the possibility that an eating disorder with deliberate omission of insulin may be the underlying cause of unexplained high blood sugars.
With support from the Hospital for Sick Children Foundation, the investigators studied 91 young women between the ages of 12 and 18 attending the Diabetes Clinic at the Hospital for Sick Children. Twenty-six reported disordered eating behaviours including the binge-eating, deliberate insulin omission, self-induced vomitting, or the use of laxatives to lose weight. The teens initially completed a self-report questionnaire and were contacted four years later for self-report questionnaires and medical evaluations. At follow up, the disordered eating behaviour persisted in 16/26 girls and was reported by an additional 14 who did not report these behaviours at baseline.
The research team sees a silver lining in this disturbing news, however. Many of the eating disorders seen in the Diabetes Clinic are mild and may be easily treated or prevented. With current support from the Medical Research Council of Canada, this research group is now evaluating the benefit of different treatments to prevent or alleviate eating disorders in young women with diabetes. Preliminary results are encouraging with one treatment approach developed with Dr. Marion Olmstead, a psychologist who is a co-investigator in the study and Head of The Toronto Hospital Eating Disorders Ambulatory Care Program.
"Adolescent girls who are concerned about their eating behaviour or diabetes management should communicate this to their diabetes specialist because effective treatment may be available," says Dr. Olmstead.
For more information, contact Josey Panetta, Senior Media Relations Officer, The Toronto Hospital, 416-340-3303
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