Eating disorders with diabetes mellitus

Eating disorders occur in children and adolescents with diabetes mellitus in up to 10 % of patients who seek treatment but frequently remain unrecognized for a long time. They are associated with a multitude of complications for the underlying disease as well as for the eating disorder. Most investigations of eating disorders are related to type 1 diabetes mellitus corresponding to the majority of patients in childhood and adolescence with this form of diabetes. This article provides an overview of the prevalence and course of eating disorders in children and adolescents with diabetes mellitus. The symptoms, somatic complications and psychosomatic treatment options are presented. Review articles and original studies were analyzed and the results are discussed. The presentation is competed by case examples from the clinical practice. The prevalence of eating disorders and disturbed eating behavior in children and adolescents with type 1 diabetes reported in clinical studies is much higher than in the general population. In contrast, a diagnosis of eating disorders in diabetes registers is less common. Insulin reduction and insulin purging are often used to avoid weight gain. Psychopathologies specific for eating disorders, such as concerns about weight and body shape in combination with insufficient metabolic control and labile blood sugar levels are typical symptoms. The short-term and long-term consequences of diabetes, such as ketoacidosis and diabetic retinopathy are typical medical complications seen in these patients. Early diagnosis and adequate treatment of eating disorders in patients with comorbid diabetes mellitus is important because of the high impact on metabolic control and to avoid physical and psychiatric long-term consequences of both disorders.