Comorbidity of diabetes mellitus and eating disorders: a follow-up study.

OBJECTIVE: There is increasing evidence that the coexistence of diabetes and eating disorders (ED) leads to poor glycemic control and an increased risk of long-term complications. METHODS: In a questionnaire- and interview-based study, a sample of 36 out of originally 38 (94.7%) diabetic patients with an ED (type-1: n=13, type-2: n=23) was assessed after a period of about 2 years in order to determine the course of EDs, body mass index (BMI), glycemic control, and psychiatric symptomatology. RESULTS: Five patients (13.9%) of the total sample showed full remission for at least 12 consecutive weeks. Twenty-two patients (61.6%) showed no change in the diagnosis of the ED. Four patients (11.1%) shifted from subclinical to clinical EDs and five patients (13.9%) vice versa. Of the eight patients who went on to psychotherapy, only one patient (12.5%) showed full remission. Emotional distress of type-2 diabetics was considerably higher compared to type-1 diabetics, which was rather low at baseline. Except interpersonal distrust as one ED-related variable, no significant change of any psychological variable could be observed in the type-1 diabetic sample during follow-up. Of the 13 type-1 diabetic patients with an ED, five patients deliberately omitted insulin in order to lose weight. These patients showed a more serious psychopathology with regard to each measured psychological variable, a higher BMI, and worse metabolic control compared to those without insulin omission. Type-2 diabetics showed a significant increase in drive for thinness and body dissatisfaction. No considerable change could be observed with regard to BMI, glycemic control, and depressive and global psychiatric symptomatology in either diabetic subsample during follow-up. CONCLUSION: EDs tended to persist over time with a considerable shift within the different types of EDs. Insulin-purging in type-1 diabetics was associated with enhanced psychopathology, higher BMI, and worse metabolic control. Both mean body mass and ED-related symptoms such as "drive for thinness" and "body dissatisfaction" increased in the average obese type-2 diabetic sample, illustrating the vicious circle of low self-esteem, enhanced restraint eating, and binge eating in weight control measures.

[Patients with diabetes mellitus: psychosocial stress and use of psychosocial support: a multicenter study]. / Patienten mit Diabetes mellitus: psychosoziale Belastung und Inanspruchnahme von psychosozialen Angeboten. Eine multizentrische Studie.

BACKGROUND: In a multicenter study the association of psychosocial stress and the use of psychosocial support in patients with diabetes mellitus was evaluated. PATIENTS AND METHOD: In a sample of 410 patients with diabetes mellitus (Type I: n 157, Type II: n = 253) stress in different facets of daily life was assessed using the revised Questionnaire on Stress in Patients with Diabetes (QSD-R). Self-constructed items were used to assess the use of psychosocial support during the course of the illness. Diabetics with a mean global stress score above standard deviation were defined as extremely handicapped and compared to the less handicapped sample. RESULTS: Extreme psychosocial stress could be found in 68 diabetics (16.6%). Not the type of diabetes but the use of insulin within the Type-II diabetic sample revealed an impact on psychosocial stress. Diabetics with extreme psychosocial stress showed worse diabetic control compared to less stressed diabetics. Profiles of psychosocial stress showed maximal stress with regard to depression in both types of diabetes; this was followed by fear of hypoglycemia in the sub-sample of Type I and physical complaints in the sub-sample of Type-II diabetics. Family members, primary care physicians and diabetologists were the main sources of psychosocial support. CONCLUSION: A considerable number of diabetic patients suffers from extreme psychosocial stress often associated with poor diabetic control. These patients need psychosocial care which should primarily be offered in diabetologic centers incorporating both the patients' family and family background.

Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study.

OBJECTIVE: Previous work suggested that the degree of psychiatric symptomatology evidenced in overweight individuals was related to the severity of binge eating problems and not related to the severity of overweight. In a multicenter study, we investigated the relationship between weight and eating disorders (EDs) in a sample of type 2 diabetic patients. METHODS: Three hundred twenty-two patients with type 2 diabetes were stratified to various weight categories. Glycemic control, eating and body-related psychological problems, self-esteem, depressive, and general psychopathology of diaetic patients with and without an ED were compared. RESULTS: Eighty-one percent of all type 2 diabetic patients were overweight or obese. Prevalence rates of EDs ranged from 6.5% to 9.0%. Binge eating disorder was the most diagnosed ED. There was a strong relationship between body mass index (BMI) and eating disturbance-related variables and a weak or no relationship between BMI and depression or general psychopathologic variables. Patients with an ED showed a greater psychopathology compared to patients without an ED. The diagnosis of an ED did not seem to have a specific influence on glycemic control. CONCLUSIONS: Our results in a type 2 diabetic sample indicate that weight might have an impact on body and eating-related psychological distress in type 2 diabetic patients, but is of minor or no importance for depressive symptomatology, lower self-esteem, and general psychiatric symptomatology. Type 2 diabetic patients with an ED, however, suffer from considerable psychiatric symptomatology.

[Comorbidity of diabetes mellitus and eating disorders. A comparison of psychological features of eating disordered and non-eating disordered patients with diabetes mellitus]. / Komorbidität von Diabetes mellitus und Essstörungen. Ein Vergleich psychologischer Störungsmerkmale essgestörter und nicht-essgestörter Patienten mit Diabetes mellitus.

As part of a multicentre study on the comorbidity of diabetes mellitus and eating disorders, the following paper compares the psychological features of diabetic patients with and without an eating disorder. In a sample of 663 diabetic patients (type 1: n = 341 type 2: n = 322), eating disorder related variables, self-esteem, body acceptance and emotional distress, especially depression in diabetic patients with and without an eating disorder, were compared. A possible relationship to diabetic control was investigated. Type 2 diabetics revealed more pronounced psychopathology in comparison to type 1 diabetics. According to our assumption, diabetic patients with an eating disorder and diabetic patients who deliberately reduced insulin in order to loose weight (insulin purging) revealed a much more severe psychopathology compared to diabetics without an eating disorder. The type of diabetes was of no importance. With the exception of the variable body and figure satisfaction in the sample of type 1 diabetes and the variable self-acceptance in the sample of type 2 diabetes, no relationship to diabetic control could be found.

[Plasma enzyme activities and acid-base equilibrium in sows in relation to the progress of labor]. / Plasmaenzymaktivitäten und Säure-Basen-Haushalt bei Sauen in Abhängigkeit vom Geburtsverlauf.

Temperature, heart rate and respiratory rate as well as enzymatic activities (CK, CK-MB, AST, LDH), and characteristics of base-acid-balance (pH, BE, pCO2, Lactate) were taken from 52 pigs during the period shortly before and after they gave birth. 16 of them dropped normally, 21 with conservative obstetrics and 15 with obstetrical laparotomy. In pigs with obstetrical laparotomy temperature fell significantly (p less than or equal to 0.01). Concerning heart rate and breathing rate there were no differences between the tested animals. CK-data rose significantly during and after birth. Maximum test data occurred in test-groups with dystocia. At the same time the increase of CK-MB-activities was above average (p less than or equal to 0.001). The other enzymes (AST, LDH) also showed a significant increase of activity in all sows, especially in case of difficult birth (p less than or equal to 0.01 to 0.0001). Lactate-concentration and the test data of base-acid-balance underwent serious changes. During anaesthesia in case of obstetrical laparotomy and during the first hours after the operation pH and BE fell and pCO2 rose. The increase of Lactate-data was above average. While we find metabolic acidosis during normal but difficult births, a respiratory acidosis caused by anaesthesia is found additionally in case of laparotomy.