EATING DISORDERS IN TYPE 1 DIABETES MELLITUS: A NARRATIVE REVIEW OF EPIDEMIOLOGY, UNDERLYING MECHANISMS, DIAGNOSIS, AND MULTIDISCIPLINARY MANAGEMENT

Abstract

Introduction: The coexistence of eating disorders (EDs) and type 1 diabetes mellitus (T1DM) represents a complex clinical challenge associated with increased morbidity and mortality. Individuals with T1DM have unique risk factors for developing eating disorders, including the psychological burden of intensive diabetes management, insulin-associated weight changes, and persistent focus on food intake and body weight. Intentional insulin restriction or omission for weight control, commonly referred to as “diabulimia,” represents a particularly concerning diabetes-specific behavior. Methods: This narrative review synthesizes current evidence regarding eating disorders and disordered eating behaviors in individuals with T1DM. A literature search was conducted using PubMed, Google Scholar, and Scopus, including peer-reviewed studies, systematic reviews, meta-analyses, and clinical guidelines, with a primary focus on publications from January 2020 to June 2026. Results: Individuals with T1DM demonstrate higher rates of eating disorders and disordered eating behaviors compared with the general population, particularly during adolescence and young adulthood. Risk development reflects interactions between biological, psychological, and social factors, including insulin-associated weight gain, body dissatisfaction, perfectionism, diabetes distress, and the demands of diabetes self-management. Insulin restriction is associated with poor glycemic control, recurrent diabetic ketoacidosis, diabetes complications, and increased mortality. Diabetes-specific screening tools, particularly the Diabetes Eating Problem Survey–Revised (DEPS-R), improve detection of clinically significant behaviors. Current evidence supports multidisciplinary management integrating diabetes care, mental health support, and nutritional expertise. Conclusion: Eating disorders in T1DM require early recognition and integrated multidisciplinary care. Routine psychological screening and diabetes-specific assessment may improve outcomes. Further research is needed to establish standardized diagnostic approaches and optimize prevention and treatment strategies.