From the Guidelines
Managing type 2 diabetes in an eating disorder program requires a comprehensive and integrated approach that prioritizes the patient's overall well-being, including their physical and mental health, as emphasized in the most recent guidelines 1.
Key Considerations
- A multidisciplinary team, including an endocrinologist, psychiatrist, dietitian, and therapist, should collaborate to address both the diabetes and eating disorder simultaneously.
- Blood glucose monitoring should be individualized, considering the use of continuous glucose monitors while being cautious of triggering obsessive behaviors.
- Medication management may involve metformin as a first-line agent, with careful consideration of insulin therapy due to potential misuse in eating disorders.
- The latest guidelines suggest considering the use of incretin therapies, such as GLP-1 RAs, for their potential in modulating food intake and reducing binge-eating behaviors 1.
Treatment Approach
- The treatment plan should focus on promoting overall health and well-being, rather than solely on diabetes management or weight loss, as rigid approaches can exacerbate eating disorder symptoms 1.
- Meal planning should emphasize regular, balanced meals that support both diabetes management and eating disorder recovery, rather than strict carbohydrate counting.
- Psychological treatment, such as cognitive behavioral therapy, is crucial in addressing the complex relationship between food, body image, and diabetes self-care.
- Physical activity should be promoted for overall health, rather than for calorie burning, and should be approached with caution to avoid triggering disordered eating behaviors.
Monitoring and Adherence
- Regular monitoring of both diabetes and eating disorder symptoms is essential, with frequent assessments of metabolic parameters, psychological status, and treatment adherence.
- The treatment team should be vigilant for signs of disordered eating and be prepared to adjust the treatment plan as needed to prioritize the patient's overall well-being 1.
From the Research
Managing Type 2 Diabetes in Eating Disorder Programs
To manage type 2 diabetes in eating disorder programs, several key points should be considered:
- The prevalence of binge-eating disorder (BED) in patients with type 2 diabetes is higher than in the general population, with studies suggesting up to 20% of patients with type 2 diabetes have an underlying eating disorder 2.
- BED is probably underdiagnosed, and simple tools can be used to improve screening for the disorder 2.
- The relationship between BED and hemoglobin A1c control can vary, but binge-eating behaviors can worsen metabolic markers, including glycemic control 2.
- Various medications used by patients with diabetes have been associated with new-onset BED, and treatment may be as simple as removing or replacing such agents 2.
- Patients with BED generally benefit from psychotherapy, including cognitive behavioral therapy 2.
Treatment Approaches
Treatment approaches for managing type 2 diabetes in eating disorder programs include:
- Introducing a regular eating pattern and supporting patients to increase their insulin dose gradually 3.
- Using medications that can reduce binge-eating frequency and potentially weight 2.
- Providing person-centered care, including adequate diabetes education and non-judgmental attitudes 4.
- Integrating type 2 diabetes and BED education and person-centered collaboration 4.
- Reframing negative thoughts surrounding binge eating disorder and diabetes self-management 5.
Patient Experiences
Patients' experiences managing co-existing type 2 diabetes and binge eating disorder include:
- Binge episodes frequently starting in childhood or adolescence and going undiagnosed for decades 5.
- Feelings of deprivation, shame, and failure exacerbating binge eating 5.
- Binge eating making diabetes self-care and outcomes worse 5.
- Improvements in both binge eating and glycemic outcomes when BED treatment and diabetes management are synergistically integrated 5.