Eating Disorders in Type 1 Diabetes: Mechanisms of Comorbidity

描述（由申请人提供）：患有1型糖尿病（T1D）的个体发生饮食失调的糖尿病相关并发症和过早死亡的风险很高。饮食失调（ED）影响了一个重要的T1D患者亚群，他们经常不使用胰岛素来控制体重。然而，这种危险的合并症流行的原因以及如何有效地治疗这些患者尚不清楚。针对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饥饿和饱腹感的影响。另一方面，患有T1D的人必须保持对血糖（BG）水平的持续认知，以确定食物摄入量，错误可能会导致可怕的后果。这可能会产生对血糖波动的不适应反应（例如，对血糖下降趋势的不控制饮食），以及不健康的尝试，以补偿在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）。我们将使用连续血糖监测仪（CGM）与日记中的心理状态和行为记录同步，研究60例饮食失调的T1D患者ED症状的前因。参与者将戴上CGM，同时被提示在一天中随机间隔完成日记记录，并记录所有进食事件。主要目的如下：1)检查T1D患者中BG波动与ED症状之间的关系，2)检查糖尿病特异性恐惧和痛苦对ED病理的贡献，3)描述T1D ED患者中胰岛素遗漏的频率和与此行为相关的心理因素。该项目的创新之处在于它侧重于T1D- ED合并症的因素，特别是BG下降作为糖尿病饮食失调的刺激因素。这项研究的方法利用了新技术的出现，这些新技术允许以以前不可行的方式检查BG波动和饮食行为之间的关系。研究结果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方法的新见解。研究结果也可能对2型糖尿病或更普遍的ED的饮食失调有启示，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。

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.