UF Researchers: Quick Survey Can Detect Bulimia, Predict Future Problems For Some Diabetic Teens

March 27, 2001

GAINESVILLE, Fla. — The answers to seven questions could mean the difference between a normal life and one plagued with serious medical afflictions for some teens with diabetes.

A simple questionnaire given to youths with insulin-dependent diabetes can detect symptoms of an eating disorder that increase the risk they’ll develop deadly complications down the road, according to a new University of Florida study.

Adolescents with diabetes who showed symptoms of bulimia were found to have soaring blood sugar levels, putting them at greater risk for blindness, nerve damage, kidney failure and other life-threatening problems earlier in life, according to UF study findings, reported in the April issue of the American Diabetes Association’s Diabetes Care.

But a brief seven-question survey could identify teens at risk for bulimia — uncontrolled binge eating — thereby allowing doctors to intervene early to help prevent those serious complications.

“Bulimia causes havoc because you eat so much that your blood sugar level skyrockets and there isn’t enough insulin in your body to manage it,” said Suzanne Bennett Johnson, the study’s principal investigator and a professor of clinical and health psychology at UF’s College of Health Professions.

“This survey could easily identify kids at risk for bulimia so clinicians could work with them to control their eating patterns and keep their blood sugars as close to normal as possible. By doing so, we can delay and actually prevent complications so these teens can live normal lives free from all these devastating problems,” said Johnson, who also serves as program director for UF’s Center for Pediatric Psychology and Family Studies.

Nearly 16 million Americans have diabetes, a disease that has no cure. It is one of the country’s most expensive medical problems, with health-care and disability costs totaling $98 billion a year, according to the National Institutes of Health, which funded the study. Most have type 2 diabetes, which results when the pancreas is unable either to make enough insulin or to use it properly. It is nearing epidemic proportions because of obesity and sedentary lifestyles.

The type 1, or insulin-dependent, form affects about 10 percent of those with diabetes. An autoimmune disease in which the body doesn’t produce any insulin, it occurs most often in children and young adults. Insulin regulates how the body uses and stores sugar and other food nutrients for energy. Without it, the body’s cells literally starve to death.

Many teen-agers, particularly girls, are obsessed with weight and body image, making them vulnerable to eating disorders. An estimated 8 million people, mainly women, have an eating disorder, which frequently starts in the teen years.

Although the UF study found adolescents with type 1 diabetes were no more likely to have an eating disorder than teens in general, the risks are complicated in youths with the disease. In order to live, they must take insulin, which has caused significant weight gain when more frequent-than-normal doses are used to control blood sugar levels.

Further clouding the picture is that bulimia is often accompanied by weight gain, which in turn further reduces the effect of insulin in the body, leading to extremely high blood sugar levels that are difficult to control.

In order to examine the relationship between control of blood sugar and eating behaviors, UF researchers studied 152 adolescents, ages 11 to 19, who had type 1 diabetes for at least a year. They were recruited from diabetes specialty clinics at the UF Health Science Center in Gainesville and Nemours Children’s Clinic in Orlando.

Results from a test that measured participants’ average blood sugar levels in the preceding two to three months were compared against their scores on the Eating Disorders Inventory, a 25-question survey used to measure attitudes and behaviors about eating. Seven of the questions were used to assess risk for bulimia. Scores on these questions were compared with norms established for healthy adolescents, with a high score indicating the presence of uncontrolled eating episodes. Other questions related to body dissatisfaction and drive for thinness.

Two extra questions were asked to determine if participants skipped insulin or took less in order to lose weight.

The study found that teens with type 1 diabetes were similar to their nondiabetic peers in both their eating behaviors and concerns about body image. Insulin-dependent teens were no more apt to show behaviors indicative of eating disorders, which has been the source of some debate in past research. While they were no more apt to show these behaviors, in those who did, the survey was useful to identify those tendencies early so they could be managed.

In seven of the study participants, all girls, a high score on the bulimia questions coincided with elevated average sugar levels in the blood, indicating poorer control. Obesity, found in nearly 11 percent of participants based on Body Mass Index standards, also corresponded to increased glucose levels and less control.

Nine participants, including four boys, admitted to skipping shots or manipulating their insulin doses to lose weight, the study found. This is particularly significant because past studies have not reported insulin misuse in males.

“Despite all the new technology and innovative discoveries, diabetes is still very crudely managed because we have not found a way to simulate what our own bodies do naturally,” Johnson said. “That’s why we’re so intent upon screening kids early for eating disorders so we can identify them in order to prevent the long-term complications.”