Eating Disorders Linked to Increased Risk of Diabetic Eye Disease

Mike Trott, BSc, MSc

A recent study from investigators at Anglia Ruskin University is highlighting the importance of proper nutrition for patients with diabetes in preventing diabetic eye disease.

A systematic review and meta-analysis of 7 studies with more than 1100 patients, results of the study provide evidence suggesting patients with eating disorders and diabetes had a 3-fold increase in likelihood of developing diabetic retinopathy than their counterparts with diabetes and without an eating disorder.

“Our review found a significant positive association between pathological eating disorders and the risk of diabetic retinopathy,” said lead investigator Mike Trott a research assistant for Anglia Ruskin University’s(ARU) Vision and Eye Research Institute, in a statement. “The most likely reason for this is poor control of blood sugar levels due to inconsistent food intake or people deliberately not taking insulin as a weight management tactic. Insulin allows the glucose in the blood stream to be converted to energy and subsequently used usefully by the body.”

As more research has examined factors associated with increased risk of complications among patients with diabetes, data has emerged suggesting specific eating pathologies may be associated with an increased risk of diabetic retinopathy. With this in mind, Trott and a team of colleagues from the ARU Vision and Eye Research Institute designed a systematic review and meta-analysis to assess aggregated risk among populations of patients with and without pathological eating behaviors, with stratification according to eating behavior.

For the purpose of analysis, investigators included all studies perorating the prevalence of pathological eating behaviors against a control group in patients with diabetes with and without diabetic retinopathy. Articles included in the study were identified through searches of the PubMed, Embase, Cinahl, PSYCinfo, Cochrane library of systematic reviews, and Opengrey databases from inception through January 6, 2021.

A total of 126 articles were identified. After exclusion of duplicates and an abstract review, 33 full-text articles underwent further screening. Of these, 7 studies, with 8 independent outcomes and total of 1162 participants, were selected for inclusion in the meta-analysis.

Upon analysis, results suggested the likelihood of diabetic retinopathy in the total pooled analysis was increased nearly 3-fold among patients with pathologic eating behaviors compared to those without such behaviors (OR, 2.94 [95% CI, 1.86-4.64]; P <.001; I2=29.59). Investigators determined there were enough data to assess odds ratios for 2 specific eating behaviors, eating disorder not otherwise specified and binge eating disorder. In these analyses, eating disorder not otherwise specified was associated with a more than 2-fold increase in likelihood of diabetic retinopathy (OR 2.73 [95% CI, 1.81-4.10]; P <.001; I2=.00), but binge eating disorder was not associated with increased likelihood (OR, 0.92 [95% CI, 0.31-2.77]; P=.887; I2=.00).

“Practitioners working with people with diabetes should closely monitor eating behaviors so that any abnormal eating behavior can be addressed swiftly to reduce the risk of diabetic retinopathy and consequent blindness if not treated.”

This study, “Pathological eating behaviours and risk of retinopathy in diabetes: a systematic review and meta-analysis,” was published in the Journal of Diabetes and Metabolic Disorders.