Department of Economics and Business Economics

Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden

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  • Ashley E. Tate, Karolinska Institutet
  • ,
  • Shengxin Liu, Karolinska Institutet
  • ,
  • Ruyue Zhang, Karolinska Institutet
  • ,
  • Zeynep Yilmaz
  • Janne T. Larsen
  • Liselotte V. Petersen
  • Cynthia M. Bulik, Karolinska Institutet, University of North Carolina
  • ,
  • Ann Marie Svensson, University of Gothenburg, Swedish National Diabetes Register
  • ,
  • Soffia Gudbjörnsdottir, University of Gothenburg, Swedish National Diabetes Register
  • ,
  • Henrik Larsson, Karolinska Institutet, Örebro University
  • ,
  • Agnieszka Butwicka, Karolinska Institutet, Medical University of Warsaw, Stockholm Health Care Services
  • ,
  • Ralf Kuja-Halkola, Karolinska Institutet

OBJECTIVE: To ascertain the association and coaggregation of eating disorders and childhood-onset type 1 diabetes in families. RESEARCH DESIGN AND METHODS: Using population samples from national registers in Sweden (n = 2,517,277) and Demark (n = 1,825,920), we investigated the within-individual association between type 1 diabetes and eating disorders and their familial coaggregation among full siblings, half siblings, full cousins, and half cousins. On the basis of clinical diagnoses, we classified eating disorders into any eating disorder (AED), anorexia nervosa (AN) and atypical AN, and other eating disorder (OED). Associations were determined with hazard ratios (HRs) with 95% CIs from Cox regressions. RESULTS: Swedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an eating disorder diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80-2.27], AN 1.63 [1.36-1.96], OED 2.34 [2.07-2.63]; Denmark: AED 2.19 [1.84-2.61], AN 1.78 [1.36-2.33], OED 2.65 [2.20-3.21]). We also meta-analyzed the results: AED 2.07 (1.88-2.28), AN 1.68 (1.44-1.95), OED 2.44 (2.17-2.72). There was an increased risk of receiving an eating disorder diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07-1.46], AN 1.28 [1.04-1.57], OED 1.28 [1.07-1.52]); these results were nonsignificant in the Danish cohort. CONCLUSIONS: Patients with type 1 diabetes are at a higher risk of subsequent eating disorders; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and an eating disorder diagnosis. Diabetes health care teams should be vigilant about disordered eating behaviors in children and adolescents with type 1 diabetes.

Original languageEnglish
JournalDiabetes Care
Pages (from-to)1143-1150
Number of pages8
Publication statusPublished - May 2021

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Publisher Copyright:
© 2021 by the American Diabetes Association.

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