We're currently reviewing our guidance on diabulimia.
While not formally recognised as a mental health condition in its own right, the Diagnostic Statistical Manual of Mental Disorders (DSM-5) considers that insulin omission in order to lose weight is a clinical feature of anorexia and bulimia. Similarly, diabulimia has also been recognised in the most recent NICE guidance for eating disorders. The section on diabetes and eating disorders covers treatment of diabulimia under the points 1.8.5 and 1.8.6.
Diabulimia is associated with an increase in retinopathy, nephropathy and foot problems, and the duration of severe insulin omission is the factor most closely associated with the development of retinopathy and nephropathy.
Standard treatments for eating disorders are not usually appropriate for cases of diabulimia. Treatment for eating disorders tend to involve removing the focus on food, which is of course contrary to recommended advice for management of Type 1 diabetes. Instead, better access is needed to diabetes specialist psychological services that can provide the integrated support that people with diabulimia need. Early intervention and referral is crucial.
An example of good practice is the service at the South London and Maudsley NHS Foundation Trust. Professionals at the trust state that treatment for diabulimia is complex and requires good physical and psychological care.
What is needed
We're calling for the following action across the UK to improve recognition and management of diabulimia, and so improve patient outcomes.
- Psychological factors should always be considered, assessed and excluded in all episodes of DKA.
- Sufficient time, resources and training must be in place to enable diabetes healthcare professionals to identify and support people with diabulimia effectively.