Effective Strategies Needed to Address Eating Disorders in Diabetes

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Treating patients with diabetes and eating disorders present a clinical challenge for physicians.
Treating patients with diabetes and eating disorders present a clinical challenge for physicians.

NEW ORLEANS — Endocrinologists and diabetes educators need to have effective strategies for managing patients with type 1 diabetes who also have eating disorders, speakers said at AADE 2015, the annual meeting of the American Association of Diabetes Educators. 

As the diabetes epidemic continues, more clinicians are seeing patients with type 1 diabetes and various eating disorders. It now appears that this patient population may be greatly underserved.

“Most of the time, diabetes educators and/or endocrinologists are the first to notice the red flags and symptoms of ED-DMT1 (eating disorder and type 1 diabetes), and there is very little information available on what to ask a patient and what to do with the information when you get it,” said Dawn Taylor, PsyD, LP, who is lead psychologist at Park Nicollet Melrose Center in Saint Louis Park, Minnesota.

Taylor and two of her colleagues addressed this topic during their presentation.

It is important for providers to increase their knowledge base so they are able to recognize this dual diagnosis, she said, adding that endocrinologists and diabetes educators need to feel comfortable being part of the treatment process and confident in making a referral for treatment.

“We have found that it is impossible to treat the two diseases separately. They must be treated together by a knowledgeable treatment team; the approach to both states is different. Often, it is difficult for providers working in diabetes care to understand why someone would actually choose not to take insulin when the consequences are so grave,” Taylor told Endocrinology Advisor.

She said the treatment process must be viewed from a psychological perspective, a medical perspective and a patient perspective. The presentation addressed the thinking patterns of individuals with diabetes when they have an eating disorder, and how this is different than seeing someone with just “out-of-control” diabetes.

Part of this presentation included a high quality voice recording of the racing, obsessive thoughts that ran through the mind of co-presenter Asha Agar Brown, founder of We Are Diabetes in Minneapolis, who once struggled with her own eating disorder.

 “This educates the audience in a way that no other venue of presentation can,” Brown told Endocrinology Advisor. “Diabetes educators are able to hear what is going on in the heads of their struggling patients.” 

Co-presenter Marcia Meier, RN, who is a program manager at Park Nicollet Melrose Center and International Diabetes Center, reenacted a typical office visit with one of her patients that she suspected needed treatment. Her gentle but effective approach showed how best to handle communication.

This is an area that may be difficult for some clinicians and it can be time consuming, she noted.

"Many diabetics, both type 1 and type 2, are struggling with disordered eating. It's important to give this concern the attention that it deserves because it will not go away. It's also important to know that there are many types of eating disorders, not just insulin omission. If an endocrinologist feels like they don't have the tools or knowledge to support one of their patients who is struggling with ED-DMT1, it's important for the provider to refer their struggling patient to someone who does,” said Brown. 

Brown's organization, We Are Diabetes, collects information on practitioners and treatment centers that have an understanding of ED-DMT1. There have been published studies on this dual diagnosis for decades, Brown said, but the actual knowledge of how to address and treat a patient with diabetes who is struggling with ED-DMT1 is still lacking.

“Sharing information about this deadly concern in the diabetes community is no longer enough. People are dying. We can prevent this with proper education and working together in unison to serve those who suffer,” said Brown.

Taylor said it is estimated that 33% of girls with type 1 diabetes will have an eating disorder. Signs that should raise red flags include an increase in HbA1c and a decrease weight, a decrease in testing of blood sugar levels and “forgetting” meter and/or records. Other signs may also be long periods of time between appointments, anxiety about being weighed and frequent glycemic lows.

Reference

  1. Meier M, Taylor D, Brown A. Effective Strategies for Identifying an Eating Disorder and Navigating Treatment Options for Patients with Type 1 Diabetes and an Eating Disorder (ED-DMT1). Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.
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