4.13.4.0 Dis­or­dered Eat­ing Be­hav­ior

Rec­om­men­da­tions

4.23 Pro­viders should con­sid­er reeval­u­at­ing the treat­ment reg­i­men of peo­ple with di­a­betes who pre­sent with symp­toms of dis­or­dered eat­ing be­hav­ior, an eat­ing dis­or­der, or dis­rupted pat­terns of eat­ing. B

4.24 Con­sid­er screen­ing for dis­or­dered or dis­rupted eat­ing using val­i­dat­ed screen­ing mea­sures when hy­per­glycemia and weight loss are unex­plained based on self-re­ported be­hav­iors re­lat­ed to med­i­ca­tion dos­ing, meal plan, and phys­i­cal ac­tiv­i­ty. In ad­di­tion, a re­view of the med­i­cal reg­i­men is rec­om­mend­ed to iden­tify po­ten­tial treat­ment-‍re­lat­ed ef­fects on hunger/‍ caloric in­take. B

Es­ti­mat­ed preva­lence of dis­or­dered eat­ing be­hav­iors and di­ag­nos­able eat­ing disor­ders in peo­ple with di­a­betes varies (102–104). For peo­ple with type 1 di­a­betes, in­sulin omis­sion caus­ing gly­co­suria in order to lose weight is the most com­monly re­ported dis­or­dered eat­ing be­hav­ior (105,106); in peo­ple with type 2 di­a­betes, binge­ing (ex­ces­sive food in­take with an ac­com­pa­ny­ing sense of loss of con­trol) is most com­monly re­ported. For peo­ple with type 2 di­a­betes treat­ed with in­sulin, in­ten­tion­al omis­sion is also fre­quent­ly re­ported (107). Peo­ple with di­a­betes and di­ag­nos­able eat­ing disor­ders have high rates of co­mor­bid psy­chi­atric disor­ders (108). Peo­ple with type 1 di­a­betes and eat­ing disor­ders have high rates of di­a­betes dis­tress and fear of hy­po­glycemia (109). When eval­u­at­ing symp­toms of dis­or­dered or dis­rupted eat­ing in peo­ple with di­a­betes, eti­ol­o­gy and mo­ti­va­tion for the be­hav­ior should be con­sid­ered (104,110). Ad­junc­tive med­i­ca­tion such as glucagon-‍like pep­tide 1 re­cep­tor ag­o­nists (111) may help in­di­vid­u­als not only to meet glycemic tar­gets but also to reg­u­late hunger and food in­take, thus hav­ing the po­ten­tial to re­duce uncon­trollable hunger and bu­lim­ic symp­toms.