Eating disorders in individuals with type 1 diabetes: case series and day hospital treatment outcome.

Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990-2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes (χ(2) = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high-risk group.

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence.

OBJECTIVE: Girls and women with type 1 diabetes are at increased risk for developing eating disorders (EDs), and these disorders are associated with serious diabetes-related medical complications. This study describes the longitudinal course of disturbed eating behavior (DEB) and EDs in a cohort with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 126 girls with type 1 diabetes receiving care for diabetes at The Hospital for Sick Children in Toronto participated in a series of seven interview-based assessments of ED behavior and psychopathology over a 14-year period, beginning in late childhood. Survival analysis was used. RESULTS: Mean age was 11.8 ± 1.5 years at time 1 and 23.7 ± 2.1 years at time 7. At time 7, 32.4% (23/71) met the criteria for a current ED, and an additional 8.5% (6/71) had a subthreshold ED. Mean age at ED onset (full syndrome or below the threshold) was 22.6 years (95% CI 21.6-23.5), and the cumulative probability of onset was 60% by age 25 years. The average time between onset of ED and subsequent ED remission was 4.3 years (95% CI 3.1-5.5), and the cumulative probability of remission was 79% by 6 years after onset. The average time between remission of ED and subsequent recurrence was 6.5 years (95% CI 4.4-8.6), and the cumulative probability of recurrence was 53% by 6 years after remission. CONCLUSIONS: In this longitudinal study, EDs were common and persistent, and new onset of ED was documented well into adulthood. Further research regarding prevention and treatment for this vulnerable group is urgently needed.

Variations in relative age effects in individual sports: skiing, figure skating and gymnastics.

In many sports, policy-makers and administrators employ annual cohorts to reduce differences between athletes during childhood and youth. Although well-intended, unintended relative age effects (RAEs) usually occur. RAEs refer to the specific selection, participation and attainment disadvantages associated with participants' birthdates relative to an arbitrary 'cutoff' date used to group participants within annual age groups. To date, we have little understanding of RAEs in individual sports. In this article, Study 1 considered the presence of RAEs in 1474 ski jumping, 7501 cross-country skiing, 15,565 alpine skiing, 4179 snowboarders and 713 Nordic combined athletes. Chi-square analyses revealed significant RAEs for most of these contexts across sexes. In Study 2, RAEs in the aesthetic sports of figure skating (n=502) and female gymnastics (n=612) were considered. There was no effect for the figure skaters and an atypical effect for the gymnasts. The significant effects across most ski sports coupled with the null effects in figure skating and atypical effect in gymnastics suggest that sport-specific contextual factors are important elements in understanding the mechanisms of RAEs, although further work is necessary to validate these findings.