1899-LB: The Predictors and Management of Eating Disorders in Adult Patients with Type 1 Diabetes Mellitus

Introduction & Objective: Eating disorders are a common issue in T1DM. The use of diabetes technologies in this patient group is controversial. In this study, we investigated the impact of eating disorders on the clinical course of T1DM and how insulin pumps affect treatment goals.

Methods: In a prospective, case-control study, the Diabetes Eating Problem Survey-Revised (DEPS-R) was used as a screening tool for diabetes-specific eating disorders in T1DM. A total score of ≥20 indicates a high risk for eating disorders. All patients were divided into 2 groups based on DEPS-R scores: those at high risk for eating disorders (n:42 cases, F/M: 26/16, age: 26.5 years, disease-duration: 11.5 years, HbA1c: %8.4, rates of minor hypoglycemic events >1 per week: %57.1, history of major hypoglycemic events on treatment: %11.9, hypoglycemia unawareness: %11.9) and those not at high risk (n:75 controls, F/M: 48/27, age: 29 years, disease-duration: 16 years, HbA1c: %7.5, rates of minor hypoglycemic events >1 per week: %60, history of major hypoglycemic events on treatment: %22.7, hypoglycemia unawareness: %13.3). Patients with confirmed or suspected Munchausen Syndrome were excluded. These 2 groups were compared in terms of clinical predictors, complications, and comorbidities. Patients at high risk for eating disorders using insulin pumps were compared with those not using pumps in terms of HbA1c, glycemic variability, and hypoglycemia.

Results: Younger age, shorter disease duration, and higher HbA1c are associated with a higher risk of eating disorders. When cases with DEPS-R scores ≥20 were compared as active pump users (n:13) versus MDI (n:29), pump provides lower HbA1c (%7.8 vs %9.4, p=0.005), lower major hypoglycemic events (%0 vs %17.2, p=0.302), and lower glycemic variability (0.66 vs 0.90, p=0.041).

Conclusion: When Munchausen Syndrome is excluded, we suggest with these data that insulin pump therapy is also safe and efficient for patients with high risk of eating disorders in T1DM.