Eating Disorders in Type 1 Diabetes: Mechanisms of Comorbidity

描述(由申请人提供)：1型糖尿病(T1D)患者如果出现进食障碍，就有很高的糖尿病相关并发症和过早死亡的风险。饮食失调(ED)影响了T1D患者的一个重要亚群，他们经常将胰岛素作为控制体重的一种手段。然而，这种危险的合并症的流行原因以及如何有效地治疗这些患者尚不清楚。为非糖尿病患者开发的干预措施未能改善T1D患者的关键代谢参数，这表明现有的饮食病理模型不适合这一独特的人群。在健康的非糖尿病人群中，饮食在很大程度上受到饥饿和饱腹感的影响。另一方面，患有T1D的人必须不断了解血糖(BG)水平以确定食物摄入量，错误可能会产生可怕的后果。这可能会产生对血糖波动的不适应反应(例如，为应对血糖下降趋势而不加控制的进食)，以及补偿血糖下降期间消耗的卡路里并重新建立情绪和行为控制(例如，胰岛素遗漏)的不健康尝试。我们将使用连续血糖监测仪(CGM)的时间同步到心理状态和行为的日记条目来研究60名饮食紊乱的T1D患者的ED症状的前驱因素。参与者将佩戴CGM，同时被提示在一天中以随机间隔完成日记记录和所有进食事件。主要目的如下：1)研究T1D患者血糖波动与ED症状之间的关系；2)研究糖尿病特有的恐惧和痛苦在ED病理中的作用；3)描述T1D合并ED患者中胰岛素遗漏的频率和与此行为相关的心理因素。这个项目的创新之处在于，它专注于T1D-ED共病的因素，特别是BG下降作为糖尿病饮食紊乱的刺激因素。这项研究的方法利用了新技术的出现，这些技术允许以以前不可行的方式来检查血糖波动和饮食行为之间的关系。这些发现可能会对我们如何理解T1D中的ED产生重大影响，并产生从根本上改变治疗的新见解。这一结果也可能对2型糖尿病患者的饮食失调有影响，或者更广泛地说，对勃起功能障碍有影响，后者是年轻女性精神疾病发病率和死亡率的主要原因之一。 公共卫生相关性：1型糖尿病(T1D)患者如果出现进食障碍，患糖尿病相关内科并发症和过早死亡的风险明显更大。饮食失调(ED)在患有T1D的个体中比在普通人群中更为普遍。然而，T1D中ED患病率增加的原因以及如何有效地治疗这些患者尚不清楚。我们将研究导致饮食紊乱和限制治疗效果的糖尿病特有因素。这项工作的最终目标是提高我们对这一危险合并症的认识，以便我们能够制定干预措施，改善这一高危群体的结局。

DESCRIPTION (provided by applicant): Individuals with type 1 diabetes mellitus (T1D) who develop an eating disorder are at high risk for diabetes- related medical complications and premature death. Eating disorders (ED) affect a significant subset of T1D patients who often withhold insulin as a means of controlling weight. Yet what accounts for the prevalence of this dangerous comorbidity and how to effectively treat these patients is unknown. Interventions developed for non-diabetic patients have failed to improve key metabolic parameters in T1D patients, suggesting extant models of eating pathology are inadequate for this unique population. Among healthy, non-diabetic populations, eating is largely regulated by the experience of hunger and satiety. Individuals with T1D, on the other hand, must remain constantly cognizant of blood glucose (BG) levels to determine food intake, and errors can have dire consequences. This may generate maladaptive reactions to BG fluctuations (e.g., uncontrolled eating in response to downward trends in BG), and unhealthy attempts to compensate for calories consumed during declining BG and re-establish emotional and behavioral control (e.g., insulin omission). We will study antecedents to ED symptoms among 60 T1D patients with disordered eating using continuous glucose monitors (CGM) time synced to diary entries of psychological state and behavior. Participants will wear the CGM while simultaneously being cued to complete diary entries at random intervals throughout the day and for all eating episodes. Primary aims are as follows: 1) Examine the relationship between fluctuations in BG and ED symptoms among T1D patients, 2) Examine the contribution of diabetes-specific fear and distress to ED pathology, and 3) Describe frequency of insulin omission and psychological factors associated with this behavior among T1D patients with ED. This project is innovative in that it focuses on factors of T1D- ED comorbidity, and specifically on BG decline as a stimulus for disordered eating in diabetes. The methodology of the study capitalizes on the advent of new technologies which allow for the examination of the relationship between fluctuations in BG and eating behavior in ways that were not feasible before. Findings could have a major impact on how we understanding ED in T1D and yield new insights that radically alter treatment. Results may also have implications for disordered eating in type 2 diabetes mellitus, or for ED more generally, one of the leading causes of psychiatric morbidity and mortality among young women. PUBLIC HEALTH RELEVANCE: Individuals with type 1 diabetes (T1D) who develop an eating disorder are at significantly greater risk for diabetes-related medical complications and premature death. Eating disorders (ED) are far more prevalent among individuals with T1D than in the general population. Yet what accounts for the increased prevalence of ED in T1D, and how to effectively treat these patients, is unknown. We will study diabetes-specific factors that contribute to disordered eating and limit treatment effectiveness. The ultimate goal of this work is to improve our understanding of this dangerous comorbidity so that we can develop interventions that improve outcomes for this high risk group.