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Insulin-dependent diabetes mellitus (IDDM) is one of the most common chronic illnesses of childhood and adolescence in North America.1 Although most young patients with IDDM are healthy, up to 40 percent eventually have diabetes-related microvascular complications.2,3 The risk is greater in those whose diabetes is poorly controlled.4 Eating behavior is categorized under three commonly selected categories.4 Highly disordered eating is defined as the occurrence of one or more of the following forms of disordered behavior at least twice per week: binge eating, omission or under dosing of insulin to promote weight loss, self-induced vomiting, or use of laxatives.4 Moderately disordered eating is defined as the occurrence of one or more of these forms of disordered behavior at least twice per month, but less than twice per week.4 Nondisordered eating is defined as the absence of disordered behavior or its occurrence less than twice per month.4 Up to one third of young women with IDDM have eating disturbances,5 which may affect the management of diabetes. Treatment of type 1 diabetes involves constant monitoring of food intake. In addition, the good glycemic control necessary to reduce the risk of long-term complications is associated with weight gain.6 In young women, these two factors, along with individual, family and social factors, can lead to an increased incidence of eating disorders, which can disrupt glycemic control and increase the risk of long-term complications.6,7,8 The coexistence of eating disorders and diabetes is associated with non-cooperation with treatment for diabetes,7 omission or under dosing of insulin to induce glycosuria and promote weight loss,8 and impaired metabolic control; 8 however, long-term effects of disordered eating on complications of diabetes are not known. Nevertheless, it is still determined that disordered eating behavior is associated with microvascular complications in young women with IDDM. From June to December 1988 (base line), 121 girls and women 12 to 18 years old were invited to participate in a self-reported survey of eating attitudes and behavior.7 These girls and women had previously diagnosed IDDM and were being followed in the diabetes clinic of the Hospital for Sick Children in Toronto. This represented all girls and women in this age group who attended the clinic during this period, except for one patient with cerebral palsy. Between July 1992 and January 1994 (follow-up), all of the participants were contacted again. Approximately one third were still attending the diabetes clinic, and the remainder had been referred to an adult treatment setting. Between study entry and follow-up, the research group did not have any contact with the study participants, except that one provided medical care for some of the patients at the clinic and another saw several patients for psychiatric assessment.
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