Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis

Aims

To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms.

Methods

We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission.

Results

A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21–0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24–0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ² = 85.83, df = 8, p < .0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26–0.34) vs. 18 % (95 % Cl 0.14–0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13–0.33).

Conclusions

Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates.