My interest in this area was triggered by one of my patients who unfortunately had anorexia nervosa and insulin dependent diabetes mellitus. This got me thinking how diagnosis of both is vital to the control and management of either one. It almost said to me `physicians and cliniciansÐbe aware!' Some recent papers have looked at the association between eating disorders and diabetes.
Stephen Herpertz and his colleagues using the Standard Interview for Anorexia and Bulimia Nervosa (SIAB-P) found that there was no difference in prevalence rates of eating disorders in IDDM and NIDDM, however the distribution was different. An interesting ®nding was that neither ED nor insulin omission was necessarily associated with poor control of glycaemia when compared with control subjects. There was a predominance of binge eating disorder in type II diabetes and then it seemed to precede the diabetes (Herpertz et al., 1998). Work from the same centre has also looked at the comorbidity of the two conditions but now in a multicentre set-up. They concluded that the prevalence of eating disorder as a whole was equal in IDDM and NIDDM. However, BN was more frequent in IDDM and BED was more frequent in NIDDM (Herpertz et al., 1998). Another study by Friedman et al. (1998) used a diagnostic interview (based on DSM-III-R criteria) and looked at the prevalence of ED in 69 insulin dependent diabetics and the relationship with somatic risks. They found no cases of AN/BN current or lifetime in the male patients with IDDM. No female patients with IDDM had anorexia, and 4.8 per cent had current and lifetime bulimia. Eating disorders not otherwise speci®ed (bulimic type) were signi®cantly more frequent in women than in men and generally occurred after the onset of IDDM. There was no association of eating disorders with somatic complications, which were more likely to be explained by long duration of illness and impaired glycaemic control. Nielsen and Mùlbak (1998) did a meta-analysis of ®ve controlled CCC 1072±4133/99/050393±03$17.50