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Letters to the Editor   |    
Type 1 Diabetes Mellitus and Mortality Risk in Patients with Anorexia Nervosa
Kim Masters, M.D.
Am J Psychiatry 2014;171:229. doi:10.1176/appi.ajp.2013.13081149
View Author and Article Information

Dr. Masters reports no financial relationships with commercial interests.

From the Three Rivers Midlands Residential Treatment Center, West Columbia, S.C.

Copyright © 2014 by the American Psychiatric Association

Accepted October , 2013.

To the Editor: The article “A Longitudinal Investigation of Mortality on Anorexia Nervosa and Bulimia Nervosa” in the August 2013 issue (1) did not mention the comorbidity of anorexia nervosa with type 1 diabetes mellitus. However, a 10-year follow-up of 150 female individuals with type 1 diabetes mellitus, 658 female individuals with anorexia nervosa, and 23 individuals with both disorders showed corresponding mortality rates of 2%, 6.5%, and 38%, respectively. Thus, concurrent type 1 diabetes mellitus and anorexia nervosa conveys a five times greater mortality rate than anorexia alone (2). It has been suggested that the increased mortality is driven by weight loss techniques of inactivating insulin or missing insulin doses to create weight loss from ketotic states and hyperglycemia (3). This technique also increases the risk of renal disease and blindness associated with retinopathy.

Franko  DL;  Keshaviah  A;  Eddy  KT;  Krishna  M;  Davis  MC;  Keel  PK;  Herzog  DB:  A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.  Am J Psychiatry 2013; 170:917–925
[CrossRef] | [PubMed]
 
Nielson  S;  Emborg  C;  Molbak  AG:  Mortality in concurrent type 1 diabetes and anorexia nervosa.  Diabetes Care 2002; 25:309–212
[CrossRef] | [PubMed]
 
Bermudez  O:  Diabetes and eating disorders.  Audio Digest Family Practice 2013; 62 (www.audio-digest.org/adfwebcasts/pdfs/fp6102.pdf)
 
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References

Franko  DL;  Keshaviah  A;  Eddy  KT;  Krishna  M;  Davis  MC;  Keel  PK;  Herzog  DB:  A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.  Am J Psychiatry 2013; 170:917–925
[CrossRef] | [PubMed]
 
Nielson  S;  Emborg  C;  Molbak  AG:  Mortality in concurrent type 1 diabetes and anorexia nervosa.  Diabetes Care 2002; 25:309–212
[CrossRef] | [PubMed]
 
Bermudez  O:  Diabetes and eating disorders.  Audio Digest Family Practice 2013; 62 (www.audio-digest.org/adfwebcasts/pdfs/fp6102.pdf)
 
References Container
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