The intersection of Type 1 Diabetes (T1DM) and eating disorders is a challenging and often misunderstood area of healthcare. The parliamentary inquiry into eating disorders in Type 1 Diabetes was published this month and it has shed light on the significant gaps in research, funding, and provision of services for individuals grappling with both conditions. As an eating disorders dietitian, it's imperative for us to understand the findings of this inquiry and work towards enhancing the support and care provided to those affected by those with TYpe 1 diabetes sand disordered eating (T1DE).
Type 1 diabetes, an autoimmune condition, sees the body's immune system attacking and destroying insulin-producing cells. T1DE, or disordered eating in a person with T1DM, manifests as individuals engage in behaviours such as intentional insulin restriction, disordered eating, and weight control, often driven by psychological distress or burnout.
The consequences of T1DE are severe, affecting both physical and mental health. Unstable blood sugar levels, diabetic ketoacidosis, malnutrition, and an increased risk of mental health disorders such as depression and anxiety are just a few of the potential complications. Without proper treatment, T1DE can be life-threatening.
Challenges in Diagnosis and Treatment
T1DE is not formally recognised as a medical diagnosis, presenting a significant hurdle in providing targeted treatment. Conflicting messages from eating disorder specialists and diabetic teams further complicate matters. These might include carbohydrate counting vs not, weight food bs not weigh food, keeping a food log vs not keeping a food log. The inquiry highlighted the need for an integrated approach to support clients with T1DE to support positive health outcomes. However, there is a shortage of health professionals that specialise in Diabetes and mental health within the NHS. This exacerbates the complexities of T1DE care. The inquiry emphasised the necessity of collaboration and integrated services to effectively manage the intricate interplay between diabetes management and disordered eating.
The lack of research funding and resources dedicated to T1DE has also hindered the development of evidence-based treatments and best practices. Recommendations from the parliamentary inquiry stress the importance of addressing this gap to define short and long-term health outcomes and evaluate best practices.
Recommendations from the report
· International consensus secured on T1DE Diagnosis
· Update NICE/SIGN guidelines improving formal treatment pathways
· T1DE pilots funded and extended into regional centres of excellence
· Increase awareness of T1DE
· Reduce stigma in diabetes and eating disorders
· Reduce incidence of T1DE
· Mental health assessment
· Transform NHS approaches to data capture and sharing, to improve clinical outcomes for T1DE
· Increase international and UK research investment to evidence intervention efficacy
· Improve education and training for health care staff to help identify and treat T1DE
· NHS workforce strategy and plan
· Support resources and peer support
As eating disorders dietitians, we play a crucial role in understanding and addressing the unique challenges faced by individuals with T1DE. But what can we do now?
Stigmatisation surrounding T1DE can hinder individuals from seeking help and receiving adequate care. As eating disorders dietitians, we have a role in actively challenging and reducing the stigma associated with T1DE. By fostering a compassionate and non-judgmental approach, we can create a safe space for individuals to open up about their experiences and seek the support they need. Allowing individuals to share their experiences and be heard is a crucial aspect of providing effective care.
Upskilling on T1DE
To meet the specific needs of individuals with T1DE, it is essential for eating disorders professionals to upskill on the complexities of supporting individual with both conditions. Join forces with your local diabetes team/eating disorders team to upskill one another. Head over to our on Demand Webinar Store for our webinar on this topic.
The findings of the parliamentary inquiry underscore the urgent need for a comprehensive, integrated approach, increased research funding, and enhanced collaboration to improve outcomes for those navigating the complex intersection of Type 1 Diabetes and eating disorders. It's time for a united effort to bridge the gap and ensure a brighter future for individuals with T1DE.
Coales, E., Hill, A., Heywood‐Everett, S., Rabbee, J., Mansfield, M., Grace, C., Beeton, I. and Traviss‐Turner, G., 2023. Adapting an online guided self‐help intervention for the management of binge eating in adults with type 2 diabetes: The POSE‐D study. Diabetic Medicine, p.e15082.
Diabates UK. Eating Disorders and Diabetes. Available Online < https://www.diabetes.org.uk/guide-to-diabetes/emotions/eating-disorders-and-diabetes>
Howarth and Mat 2024. Type 1 diabetes and disordered eating: Parliamentary Inquiry . Available online - http://diabetes-resources-production.s3.eu-west-1.amazonaws.com/resources-s3/public/2024-01/TYPE1_A4_PAPER_JANUARY_2024_SCREEN.pdf
Partridge, H., Figueiredo, C., Rouse, L., Cross, C., Pinder, C., Ryder, J., Bennett, M. and Stacey, N., 2020. Type 1 diabetes and disordered eating (T1DE): the ComPASSION Project–Wessex. Practical Diabetes, 37(4), pp.127-132.
Royal College of Psychiatry 2023. Medical Emergencies in Eating Disorders (MEED). Annex 3 - https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233---annexe-3.pdf?sfvrsn=c45bd860_14
Type 1 diabetes and disordered eating: Parliamentary Inquiry . http://diabetes-resources-production.s3.eu-west-1.amazonaws.com/resources-s3/public/2024-01/TYPE1_A4_PAPER_JANUARY_2024_SCREEN.pdf