General Hospital Psychiatry xxx (2015) xxx–xxx
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Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients Selime Çelik, M.D. a,⁎, Yusuf Kayar, M.D. b, Rabia Önem Akçakaya, M.D. c, Ece Türkyılmaz Uyar, M.D. a, Kübra Kalkan, M.D. b, Veli Yazısız d, Çiğdem Aydın a, Başak Yücel e a
Sisli Etfal Research and Training Hospital Psychiatry Unıt, Sisli-İstanbul, Turkey Sisli Etfal Research and Training Hospital Internal Medicine Unıt, Sisli-İstanbul, Turkey Nevşehir State Hospital, Psychiatry Unit, Nevşehir, Turkey d Akdeniz University Department of Internal Medicine, Antalya, Turkey e Istanbul University Medical School Psychiatry Unıt, Istanbul, Turkey b c
a r t i c l e
i n f o
Article history: Received 23 September 2014 Revised 25 November 2014 Accepted 27 November 2014 Available online xxxx Keywords: Type 2 diabetes mellitus Binge eating disorder Depression Glycemic control
a b s t r a c t Objective: It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control. Method: One hundred fifty-two T2DM patients aged between18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores. Results: Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (Pb .05). A positive correlation was found between EAT scores and depression scores (r=+0.196, Pb.05). No significant difference was found in HbA1c levels between patients with BED and those without (Pb .05). Conclusions: T2DM patients should be examined in terms of the presence of BED and disordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression. © 2014 Elsevier Inc. All rights reserved.
1. Introduction Diabetes mellitus (DM) has become increasingly common throughout the world [1]. In a study conducted in 2010, the incidence in adults was reported as 6.4% [2]. Type 1 diabetes is related to insulin deficiency, whereas type 2 diabetes is related to insulin resistance secondary to obesity [3]. More than 80% of all patients had type 2 diabetes, whereas in Turkey, the prevalence of type 2 diabetes is about 2.5%–6% [4]. Psychiatric disorders such as eating disorders and depression are quite common in patients with type 2 diabetes mellitus (T2DM) [5,6]. PibernikOkanovic et al. [7] reported major depression at a rate of 33% in T2DM patients, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria, whereas TéllezZenteno and Cardiel [8] reported depression at a rate of 39%. In a study conducted in Turkey [9], the incidence of major depression in T2DM patients was reported as 58.9%, according to DSM-IV diagnostic criteria, whereas in another study [10], it was reported as 47%.
⁎ Corresponding author. E-mail address: [email protected] (S. Çelik).
It has been found that in T2DM patients, weight gain, body dissatisfaction, history of dieting and depression play a role in the development of eating disorders [11]. It has also been established that the most common eating disorder is binge eating disorder (BED) in this group [6]. The prevalence of BED in the general population is 3.5% in females and 2% in males [12], while it has been reported in studies of T2DM patients that the prevalence is in the range of 2.5%–25.6% [13,6]. BED is a disorder that is included under the eating disorder not otherwise specified (EDNOS) diagnostic category in DSM-IV. The research diagnostic criteria for BED are listed in Annex B of DSM-IV and DSM-IV-TR [14]. BED is quite similar to bulimia nervosa which is recurrent episodes of binge eating and losing control of eating during these episodes. BED does not involve inappropriate compensatory behaviors that occur in bulimia nervosa for the aim of avoiding weight gain, such as use of laxatives, excessive exercise and vomiting, whereas BED involves eating more rapidly than normal, eating despite lack of physical hunger, and eating until feeling uncomfortably full. Eating episodes that involve these criteria happen for at least 6months and at least two times a week. In the studies conducted with T2DM patients, BED has been a focus [15]. In this patient group, dietary limitations may cause disorders in eating attitudes and binge eating episodes [16]. It is reported that patients with BED show
http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012 0163-8343/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
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S. Çelik et al. / General Hospital Psychiatry xxx (2015) xxx–xxx
higher rates of depression [17,6] and that depressive symptoms may cause a disorder in eating attitudes [18]. It is also debated in T2DM patients whether disordered eating attitudes and binging episodes are correlated with glycemic control [6,19]. Based on the above information in the literature, this study aimed to test three hypotheses: (1) the prevalence of BED will be higher in T2DM patients that apply to the hospital than in the general population; (2) there is a significantly positive correlation between BED and level of depression; and (3) BED adversely affects glycemic control. 2. Materials and methods 2.1. Participants and procedures Our inclusion criteria included 152 patients between ages 18 and 75 years. They were drawn from patients who were followed at the Diabetes Outpatient Clinic of Şişli Etfal Training and Research Hospital for T2DM between the dates 01.03.2013–01.06.2013, with consecutive applications to the clinic. Our exclusion criteria were as follows: (1) illiterate patients; (2) patients with mental retardation; (3) those with delirium, dementia, amnesic or other cognitive disorders; (4) schizophrenia and other psychotic disorders; (5) mood disorders; (6) alcohol and substance abuse and addiction according to DSM-IV diagnostic criteria; and (7) those using any kind of psychotropic drugs. Before the study began, necessary permission was obtained from the ethics committee of our hospital (no. 342, dated 19.02.2013). Patients were informed of the aim and grounds of the study and those patients who signed the approval form were included. Diabetes patients included in the study were given a sociodemographic and clinical characteristics form, Eating Attitudes Test (EAT) [20] and Beck Depression Scale (BDS) [21]. Diagnosis of an eating disorder was reached by psychiatrist who was blinded to the study, upon application of the eating disorder section of the Turkish language form [22] of Structured clinic interview research form for Axis 1 disorders [23]. In the study, the body mass index (BMI; kg/m2), glycosylated hemoglobin (HbA1c) levels showing the glucose level of the last 120days in the blood, as well as the compliance to diet and exercise and drug use were recorded. Those with BMI b 25kg/m 2 were evaluated as normal weight, 25–29.9kg/m 2 were overweight and those ≥ 30 were obese [24]. HbA1c values b 7% were regarded as good glycemic control, and HbA1c values ≥7% were regarded as poor glycemic control [25]. Dietitian supervised the patients ≥3days a week was considered as dietary compliance. Exercising for at least half an hour ≥3days a week was considered as exercise compliance, whereas failure to take drugs ≥1 times a week was considered as noncompliance to drug (treatment) and taking the drugs regularly was considered as drug (treatment) compliance [25]. 2.2. Measures 2.2.1. Sociodemographic and clinical characteristics form This is a semistructured interview chart in which information such as age, gender and educational level is investigated, and clinical characteristics on diabetes (BMI, duration of the disease, HbA1C, dietary compliance, exercise compliance, treatment compliance, etc.) are also included. 2.2.2. Eating Attitudes Test This is a 40-item scale based on self-reporting. It was developed by Garner and Garfinkel [20] for screening purposes in order to detect adolescents older than eleven who have eating disorders. It was developed with the aim of evaluating possible disorders in eating attitudes of patients both with and without eating disorders. The validity and reliability of the Turkish version was established by Erol and Savaşır [26]. In this study, 30 points and above was considered as the cutoff score for disordered eating attitude.
Table 1 Sociodemographic and clinical characteristics. N Age, mean years (S.D.) Sex, % Male Female Education, % Less than high school graduate High school graduate University/College Duration of DM, mean years HbA1c BMI Exercise compliance, % Diet compliance, % Medication compliance, % BDS Total score (S.D.) b17, % ≥17, % EAT Total score b30, % ≥30, %
152 55.0 (9.2) 46.7 53.3 83.6 10.5 5.9 6.41 (6.2) 8.11 (2.0) 30.99 (5.0) 44.1 41.4 67.8 9.53 (7.73) 81.6 18.4 24.82 (11.31) 70.4 29.6
S.D.: standart deviation; HbA1c: hemoglobin A1c.
2.2.3. Beck Depression Scale This measures physical, emotional and cognitive symptoms observed in depression. It is a self-evaluation scale that includes 21 symptom categories. It was developed by Beck et al. [21], and the validity and reliability of the Turkish version was established by Hisli et al. [27]; the cutoff score was determined as 17. 2.3. Statistical analysis The data were analyzed using SPSS 17.0/Windows. Descriptive statistics were used in the evaluation of the general characteristics of the patients and the survey test data. Between-groups significances were evaluated using chi-square and Fisher tests for qualitative data and independent-samples t test, Mann–Whitney U and Kruskal–Wallis tests for quantitative data. The correlations between age, HbA1c, BMI, BDS and EAT scale scores were evaluated through Spearman correlation analysis. The limit for statistical significance was set as Pb .05. 3. Results Of the 152 patients included in the study, 53.3% (n= 81) were females and 46.7% (n= 71) were males. Average age was 55.01±9.23 and the duration of diabetes was 6.41±6.25. The demographic and clinical characteristics of the patients are summarized in Table 1. One patient was diagnosed with EDNOS and 8 (5.26%) with BED. No anorexia nervosa or bulimia nervosa cases were detected. The average BDS score was 9.53±7.73, whereas the average EAT scale score was 24.82±11.31. Forty-five patients (29.6%) who scored 30 points or above on the EAT scale were considered to have a disordered eating attitude (Table 1).
Table 2 Analysis of HbA1c, BMI and scores of the scales according to sex (N=152). Mean (S.D.)
HbA1c (S.D.) BMI BDS, total score EAT, total score
P unadjusted
Male (n=71)
Female (n=81)
7.86 (1.79) 29.44 (3.64) 7.98 (6.62) 21.45 (9.60)
8.32 (2.23) 32.36 (5.65) 10.91 (8.40) 27.77 (11.92)
.163 .000 .020 .001
HbA1c: hemoglobin A1c; S.D.: standart deviation.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
S. Çelik et al. / General Hospital Psychiatry xxx (2015) xxx–xxx Table 3 Correlations (n=152).a
Age HbA1c BDS EAT BMI
Age
HbA1c
BDI
EAT
1 −.100 −.038 −.025 .014
−.100 1 .145 −.046 .092
−.038 .145 1 .196a .105
−.025 −.046 .196a 1 .136
BMI .014 .092 .105 .136 1
HbA1c: hemoglobin A1c. a Unadjusted analysis.
An evaluation of the scale values of the patients included in the study in terms of gender revealed that the total BDS scores of female patients was 10.91±8.40, whereas it was 7.98±6.62 in male patients. The depression scores of female patients were significantly higher than those of male patients (P=.020). The total EAT score of female patients was 27.77±11.92, whereas it was 21.45±9.60 in male patients, showing a statistically significant difference (P=.001). The BMI of female patients was significantly higher than that of male patients (Pb .001) (Table 2). In the analyses conducted with the Kruskal–Wallis test, normal-weight (BMI: b25kg/m 2), overweight (BMI: 25–29.9kg/m 2) and obese (BMI: ≥30kg/m2) patients were not different in terms of BDS and EAT scores (PN.05). The depression scores of patients with BED were significantly higher than those of patients without BED (P=.003). The EAT score in patients with BED was 33.25±15.62, whereas it was 24.35±10.91 in patients without BED, the difference being statistically significant (P= .030). No significant difference was found between the HbA1c levels of patients with or without BED (P= .384). No difference was detected between patients with or without BED in terms of dietary compliance (P=1.000, Fisher's exact), treatment compliance (P=.743) or exercise compliance (P=.729) (Table 3). In the correlation analysis, a significant positive correlation was detected between patients' EAT scale scores and BDS scores (r=+0.196, Pb.05) (Table 3). The association between BED and depression was adjusted confounding age, gender, HbA1c and duration of T2DM. After adjusment, the statistical significance did not change (Table 4). 4. Discussion In this study, in which we researched the prevalence of BED in T2DM patients and the correlation between BED and the level of depression and glycemic control, we found that BED is more common in this group than in the general population, i.e., 5.26%. This result confirms the results of previous studies [13,6] that reported the prevalence of BED in T2DM patients as 2.5%–25.6%. Differences in the prevalence are explained through sample characteristics in studies, diagnostic criteria
3
applied and country-based differences in prevalence [15]. Allison et al. [17] found the rate of BED among T2DM patients to be 1.4%, and this was explained by the advanced average age (average age: 60) of the study samples. In our study, those diagnosed with BED were younger and more obese than those who were not, but the difference was not statistically significant. Our results support the results of previous studies [28,29] in which it has been reported that there was no difference in terms of age and BMI between T2DM patients with and without BED. Kenardy et al. [30] reported that diabetic patients with BED were younger than those without BED, and they were also diagnosed with diabetes at an earlier age and might have developed diabetes due to the eating disorder. Kenardy et al. [30] related the existence of BED with high BMI. It is still debated whether BED is effective in the development of diabetes or whether diabetes facilitates the development of BED symptoms. Manucci et al. [13] reported that BED increases weight gain and is a risk factor in the development of T2DM. Yannakoulia [15] claimed that the age of onset of T2DM is later than the age of onset of the eating disorder, that diabetes may facilitate the development of the symptoms for BED and that BED is not a simple variable regarding weight. In our study, we verified our second hypothesis that in patients diagnosed with BEDs, the level of depression is higher. Similar results were also reported in previous studies [31,17,32]. It may be concluded that the coexistence of BED in T2DM patients is a situation that requires more extensive psychiatric support. In addition, our findings that T2DM patients show disordered eating attitudes at a rate of 29.6% and that there is a positive correlation between EAT scores and depression scores necessitate the evaluation of disordered eating attitudes in these patients in addition to BED and examination for depressive symptoms. It has been reported that T2DM patients diagnosed with BED show more dietary, exercise and treatment noncompliance than those who are not diagnosed with BED [30]. The fact that BED was diagnosed in only eight individuals in our study restricts from further comment on the relation between BED and dietary, exercise and treatment compliance. Upon testing the third hypothesis of our study, we found that the HbA1c value was not different in T2DM patients with or without BED. This result supports the results of previous studies [6,31,33] that found that BED was unrelated to glycemic control. In a study that evaluated the effect of BED on diabetes control through HbA1c [30], it was conversely found that the influence of BED on diabetes control was moderate. In a study that researched the effect of BED on glycemic control in T2DM patients in Turkey, it was concluded that BED adversely affected glycemic control [29]. The difference in the results may be explained by the fact that the average age of the participants in the study by Canan et al. [29] were younger than the patients in our study, and the majority of them (65.8%) were females. It has been reported that female
Table 4 Comparison of diabetic patients with and without BED. With BED (n=8)
Without BED (n=144)
Age, years (mean±S.D.) Sex Male (n) Female (n) Duration of DM (mean±S.D.) HbA1c (mean±S.D.) BMI (kg/m2, mean±S.D) BDS, total score (mean±S.D.) EAT, total score (mean±S.D.) Diet compliance (n)
50.75±4.97
55.24±9.36
4 4 4.75±1.66 8.72±3.26 33.78±6.78 17.25±11.69 33.25±15.62 3
67 77 6.5±6.4 8.07±1.96 30.84±4.88 9.11±7.28 24.35±10.91 60
Exercise compliance (n) Treatment compliance (n)
4 5
63 98
P unadjusted
Adjusted
.181 .848
– –
.443 .384 .107 .003 .030
– – – .004 .023 –
1.000* .720 .743
– –
S.D.: standart deviation; HbA1c: hemoglobin A1c. * Fischer exact test. Analysis were adjusted acoording to age, gender, duration of DM and HbA1c.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
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S. Çelik et al. / General Hospital Psychiatry xxx (2015) xxx–xxx
gender is implicated in the development of BED in T2DM [11]. Yet, a study conducted in Turkey with a total of 110 DM (34 T1DM and 76 T2DM) patients revealed no differences in the HbA1c levels of patients with or without eating attitude disorders [34]. There are four main limitations of our study: (1) We did not plan this study as multicentral; otherwise, more number of patients might be included. (2) The prevalence of eating disorders and especially BED was not researched in a control group of healthy individuals, because we aimed to research BED in patients with T2DM only, not to compare with the control group. (3) We designed this study according to DSMIV criteria, because when we planned this study, DSM-V criteria were not published yet. Since the number of eating episodes and the period reduced in the new criteria, if we have taken into consideration the DSM-V, we have found opportunity for diagnosing more patients as BED. (4) Since the number of patients with BED was low, which was another limitation of our study, we have proposed further studies including a great number of patients in the future. 5. Conclusion Our study is the first one in Turkey that examined BED in T2DM patients, including level of depression and clinical characteristics related to diabetes (HbA1c levels, BMI, dietary compliance, etc.) in patients diagnosed with and without BED. Our results show a relation between BED in T2DM patients and level of depression. The clinicians who treat diabetes should ask for a psychiatric consultation in cases where they detect disordered eating attitudes and BED, and organize the treatments in a multidisciplinary way by taking into consideration psychopathologies of the patients other than eating disorders. It should also be noted that there is a need for further studies that are multicentered and involve larger samples, which research psychiatric comorbidity and especially eating disorders in T2DM patients. References [1] King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414–31. [2] Shaw JE, Sucre RA, Zimmet PZ. Global estimates for the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4–14. [3] Crow SJ, Keel PK, Kendall D. Eating disorders and insulin-dependent diabetes mellitus. Psychosomatics 1998;39(3):233–43. [4] Bagrıaçık N. Tanı, komplikasyonlara yaklaşım, tedavi konsensus el kitabı. Novo Nordisk diyabet servisi yayınları. İstanbul: Şişli Etfal Tıp Bülteni; 1997. [5] Pouwer F, Beekman AT, Nijpels G, Dekker JM, Snoek FJ, Kostense PJ, et al. Rates and risks for co-morbid depression in patients with type 2 diabetes mellitus: results from a community-based study. Diabetologia 2003;46(7):892–8. [6] Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type 2 diabetes mellitus. Int J Eat Disord 2001;30:222–6. [7] Pibernik-Okanovic M, Peros K, Szabo S, Begic D, Metelko Z. Depression in Croatian type 2 diabetic patients: prevalence and risk factors. A Croatian survey from the European Depression in Diabetes (EDID) Research Consortium. 2005;22(7):942–5. [8] Téllez-Zenteno JF, Cardiel MH. Risk factors associated with depression in patients with type 2 diabetes mellitus. Arch Med Res 2002;33(1):53–60. [9] Eren İ, Erdi Ö, Özcankaya R. Tip II Diabetik Hastalarda Kan Şekeri Kontrolü İle Psikiyatrik Bozuklukların İlişkisi. Türk Psikiyatri Dergisi 2003;14(3):184–91.
[10] Özdemir İ, Hocaoğlu Ç, Koçak M, Ersöz Ö. Tip 2 diyabetes mellituslu hastalarda yaşam kalitesi ve ruhsal belirtiler. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2011;24:128–38. [11] Pinhas-Hamiel O, Levy-Shraga Y. Eating disorders in adolescents with type 2 and type 1 diabetes. Curr Diab Rep 2013;13(2):289–97. [12] Wonderlich SA, Gordon KH, Mitchell JE, Crosby RD, Engel SG. The validity and clinical utility of binge eating disorder. Int J Eat Disord 2009;42(8):687–705. [13] Mannucci E, Tesi F, Ricca V, Pierazzuoli E, Barciulli E, Moretti S, et al. Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord 2002;26(6):848–53. [14] American Psychiatric Association. DSM-IV — Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994. [15] Yannakoulia M. Eating behavior among type 2 diabetic patients: a poorly recognized aspect in a poorly controlled disease. Rev Diabet Stud 2006;3(1):11–6. [16] Westenhoefer J, Broeckmann P, Munch AK, Pudel V. Cognitive control of eating behaviour and the disinhibition effect. Appetite 1994;23(1):27–41. [17] Allison KC, Crow SJ, Reeves RR, West DS, Foreyt JP, Dilillo VG, et al. Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity (Silver Spring) 2007;15(5):1287–93. [18] Brownstone LM, Bardone-Cone AM, Fitzsimmons-Craft EE, Printz KS, Le Grange D, Mitchell JE. Subjective and objective binge eating in relation to eating disorder symptomatology, negative affect, and personality dimensions. Int J Eat Disord 2013;46(1):66–76. [19] Herpertz S, Albus C, Wagener R, Kocnar M, Wagner R, Henning A, et al. Comorbidity of diabetes and eating disorders. Does diabetes control reflect disturbed eating behavior? Diabetes Care 1998;21(7):1110–6. [20] Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979;9:273–9. [21] Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71. [22] Özkürkçigil A, Aydemir Ö, Yıldız M, Esen Danacı A, Köroğlu E. DSM-IV Eksen-I Bozuklukları İçin Yapılandırılmış Klinik Görüşmenin Türkçe'ye Uyarlanması ve Güvenilirlik Çalışması. İlaç Tedavi Dergisi 1999;12(4):233–6. [23] First MB, Spitzer RL, Gibbon M, Williams JBW. Structed Clinical Interview for DSM IV Axis Disorders (SCID-I) Clinical Version. Washington D.C. and London: American Psychiatric Press, Inc; 1997. [24] World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva, Switzerland: World Health Organization; 2000 [Technical report series no. 894]. [25] American Diabetes Association. Standards of Medical Care in Diabetes — 2013. Diabetes Care 2013;36(Suppl. 1):11–66. [26] Erol N, Savasir I. Yeme Tutum Testi: Anoreksia nevroza belirtileri indeksi. Türk Psikoloji Dergisi 1989;23:132–6. [27] Hisli N. Beck Depresyon Envanterinin geçerliliği üzerine bir çalışma. Türk Psikoloji Dergisi 1988;6:118–26. [28] Wilfley D, Berkowitz R, Goebel-Fabbri A, Hirst K, Ievers-Landis C, Lipman TH, et al. Binge eating, mood, and quality of life in youth with type 2 diabetes. Diabetes Care 2011;34:858–60. [29] Canan F, Güngör A, Onder E, Celbek G, Aydın Y, Alcelik A. Tip 2 Diyabet Hastalarında Tıkınırcasına Yeme Bozukluğu ve Glisemik Kontrol Arasındaki İlişki. Turk J Endocrinol Metab 2011;15:26–7. [30] Kenardy J, Mensch M, Bowen K, Green B, Walton J, Dalton M. Disordered eating behaviours in women with type 2 diabetes mellitus. Eat Behav 2001;2(2): 183–92. [31] Wing RR, Marcus MD, Epstein LH, Blair EH, Burton LR. Binge eating in obese patients with type II diabetes. Int J Eat Disord 1989;8:671–9. [32] Morse SA, Ciechanowski PS, Katon WJ, Hirsch IB. Isn't this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes. Diabetes Care 2006;29(8):1800–4. [33] Herpertz S, Albus C, Lichtblau K, Köhle K, Mann K, Senf W. Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study. Int J Eat Disord 2000;28(1):68–77. [34] Ustunsoy S, Altuntaş Y, Karamustafalıoğlu O, Şengül A, Çobanoğlu N. Tip 1 ve Tip 2 Diyabetes Mellitus Hastalarında Yeme Bozuklukları ve Bozulmuş Yeme Davranışı. Düşünen Adam 2008;21(1–4):24–31.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
Contents lists available at ScienceDirect
General Hospital Psychiatry journal homepage: http://www.ghpjournal.com
Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients Selime Çelik, M.D. a,⁎, Yusuf Kayar, M.D. b, Rabia Önem Akçakaya, M.D. c, Ece Türkyılmaz Uyar, M.D. a, Kübra Kalkan, M.D. b, Veli Yazısız d, Çiğdem Aydın a, Başak Yücel e a
Sisli Etfal Research and Training Hospital Psychiatry Unıt, Sisli-İstanbul, Turkey Sisli Etfal Research and Training Hospital Internal Medicine Unıt, Sisli-İstanbul, Turkey Nevşehir State Hospital, Psychiatry Unit, Nevşehir, Turkey d Akdeniz University Department of Internal Medicine, Antalya, Turkey e Istanbul University Medical School Psychiatry Unıt, Istanbul, Turkey b c
a r t i c l e
i n f o
Article history: Received 23 September 2014 Revised 25 November 2014 Accepted 27 November 2014 Available online xxxx Keywords: Type 2 diabetes mellitus Binge eating disorder Depression Glycemic control
a b s t r a c t Objective: It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control. Method: One hundred fifty-two T2DM patients aged between18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores. Results: Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (Pb .05). A positive correlation was found between EAT scores and depression scores (r=+0.196, Pb.05). No significant difference was found in HbA1c levels between patients with BED and those without (Pb .05). Conclusions: T2DM patients should be examined in terms of the presence of BED and disordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression. © 2014 Elsevier Inc. All rights reserved.
1. Introduction Diabetes mellitus (DM) has become increasingly common throughout the world [1]. In a study conducted in 2010, the incidence in adults was reported as 6.4% [2]. Type 1 diabetes is related to insulin deficiency, whereas type 2 diabetes is related to insulin resistance secondary to obesity [3]. More than 80% of all patients had type 2 diabetes, whereas in Turkey, the prevalence of type 2 diabetes is about 2.5%–6% [4]. Psychiatric disorders such as eating disorders and depression are quite common in patients with type 2 diabetes mellitus (T2DM) [5,6]. PibernikOkanovic et al. [7] reported major depression at a rate of 33% in T2DM patients, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria, whereas TéllezZenteno and Cardiel [8] reported depression at a rate of 39%. In a study conducted in Turkey [9], the incidence of major depression in T2DM patients was reported as 58.9%, according to DSM-IV diagnostic criteria, whereas in another study [10], it was reported as 47%.
⁎ Corresponding author. E-mail address: [email protected] (S. Çelik).
It has been found that in T2DM patients, weight gain, body dissatisfaction, history of dieting and depression play a role in the development of eating disorders [11]. It has also been established that the most common eating disorder is binge eating disorder (BED) in this group [6]. The prevalence of BED in the general population is 3.5% in females and 2% in males [12], while it has been reported in studies of T2DM patients that the prevalence is in the range of 2.5%–25.6% [13,6]. BED is a disorder that is included under the eating disorder not otherwise specified (EDNOS) diagnostic category in DSM-IV. The research diagnostic criteria for BED are listed in Annex B of DSM-IV and DSM-IV-TR [14]. BED is quite similar to bulimia nervosa which is recurrent episodes of binge eating and losing control of eating during these episodes. BED does not involve inappropriate compensatory behaviors that occur in bulimia nervosa for the aim of avoiding weight gain, such as use of laxatives, excessive exercise and vomiting, whereas BED involves eating more rapidly than normal, eating despite lack of physical hunger, and eating until feeling uncomfortably full. Eating episodes that involve these criteria happen for at least 6months and at least two times a week. In the studies conducted with T2DM patients, BED has been a focus [15]. In this patient group, dietary limitations may cause disorders in eating attitudes and binge eating episodes [16]. It is reported that patients with BED show
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Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
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S. Çelik et al. / General Hospital Psychiatry xxx (2015) xxx–xxx
higher rates of depression [17,6] and that depressive symptoms may cause a disorder in eating attitudes [18]. It is also debated in T2DM patients whether disordered eating attitudes and binging episodes are correlated with glycemic control [6,19]. Based on the above information in the literature, this study aimed to test three hypotheses: (1) the prevalence of BED will be higher in T2DM patients that apply to the hospital than in the general population; (2) there is a significantly positive correlation between BED and level of depression; and (3) BED adversely affects glycemic control. 2. Materials and methods 2.1. Participants and procedures Our inclusion criteria included 152 patients between ages 18 and 75 years. They were drawn from patients who were followed at the Diabetes Outpatient Clinic of Şişli Etfal Training and Research Hospital for T2DM between the dates 01.03.2013–01.06.2013, with consecutive applications to the clinic. Our exclusion criteria were as follows: (1) illiterate patients; (2) patients with mental retardation; (3) those with delirium, dementia, amnesic or other cognitive disorders; (4) schizophrenia and other psychotic disorders; (5) mood disorders; (6) alcohol and substance abuse and addiction according to DSM-IV diagnostic criteria; and (7) those using any kind of psychotropic drugs. Before the study began, necessary permission was obtained from the ethics committee of our hospital (no. 342, dated 19.02.2013). Patients were informed of the aim and grounds of the study and those patients who signed the approval form were included. Diabetes patients included in the study were given a sociodemographic and clinical characteristics form, Eating Attitudes Test (EAT) [20] and Beck Depression Scale (BDS) [21]. Diagnosis of an eating disorder was reached by psychiatrist who was blinded to the study, upon application of the eating disorder section of the Turkish language form [22] of Structured clinic interview research form for Axis 1 disorders [23]. In the study, the body mass index (BMI; kg/m2), glycosylated hemoglobin (HbA1c) levels showing the glucose level of the last 120days in the blood, as well as the compliance to diet and exercise and drug use were recorded. Those with BMI b 25kg/m 2 were evaluated as normal weight, 25–29.9kg/m 2 were overweight and those ≥ 30 were obese [24]. HbA1c values b 7% were regarded as good glycemic control, and HbA1c values ≥7% were regarded as poor glycemic control [25]. Dietitian supervised the patients ≥3days a week was considered as dietary compliance. Exercising for at least half an hour ≥3days a week was considered as exercise compliance, whereas failure to take drugs ≥1 times a week was considered as noncompliance to drug (treatment) and taking the drugs regularly was considered as drug (treatment) compliance [25]. 2.2. Measures 2.2.1. Sociodemographic and clinical characteristics form This is a semistructured interview chart in which information such as age, gender and educational level is investigated, and clinical characteristics on diabetes (BMI, duration of the disease, HbA1C, dietary compliance, exercise compliance, treatment compliance, etc.) are also included. 2.2.2. Eating Attitudes Test This is a 40-item scale based on self-reporting. It was developed by Garner and Garfinkel [20] for screening purposes in order to detect adolescents older than eleven who have eating disorders. It was developed with the aim of evaluating possible disorders in eating attitudes of patients both with and without eating disorders. The validity and reliability of the Turkish version was established by Erol and Savaşır [26]. In this study, 30 points and above was considered as the cutoff score for disordered eating attitude.
Table 1 Sociodemographic and clinical characteristics. N Age, mean years (S.D.) Sex, % Male Female Education, % Less than high school graduate High school graduate University/College Duration of DM, mean years HbA1c BMI Exercise compliance, % Diet compliance, % Medication compliance, % BDS Total score (S.D.) b17, % ≥17, % EAT Total score b30, % ≥30, %
152 55.0 (9.2) 46.7 53.3 83.6 10.5 5.9 6.41 (6.2) 8.11 (2.0) 30.99 (5.0) 44.1 41.4 67.8 9.53 (7.73) 81.6 18.4 24.82 (11.31) 70.4 29.6
S.D.: standart deviation; HbA1c: hemoglobin A1c.
2.2.3. Beck Depression Scale This measures physical, emotional and cognitive symptoms observed in depression. It is a self-evaluation scale that includes 21 symptom categories. It was developed by Beck et al. [21], and the validity and reliability of the Turkish version was established by Hisli et al. [27]; the cutoff score was determined as 17. 2.3. Statistical analysis The data were analyzed using SPSS 17.0/Windows. Descriptive statistics were used in the evaluation of the general characteristics of the patients and the survey test data. Between-groups significances were evaluated using chi-square and Fisher tests for qualitative data and independent-samples t test, Mann–Whitney U and Kruskal–Wallis tests for quantitative data. The correlations between age, HbA1c, BMI, BDS and EAT scale scores were evaluated through Spearman correlation analysis. The limit for statistical significance was set as Pb .05. 3. Results Of the 152 patients included in the study, 53.3% (n= 81) were females and 46.7% (n= 71) were males. Average age was 55.01±9.23 and the duration of diabetes was 6.41±6.25. The demographic and clinical characteristics of the patients are summarized in Table 1. One patient was diagnosed with EDNOS and 8 (5.26%) with BED. No anorexia nervosa or bulimia nervosa cases were detected. The average BDS score was 9.53±7.73, whereas the average EAT scale score was 24.82±11.31. Forty-five patients (29.6%) who scored 30 points or above on the EAT scale were considered to have a disordered eating attitude (Table 1).
Table 2 Analysis of HbA1c, BMI and scores of the scales according to sex (N=152). Mean (S.D.)
HbA1c (S.D.) BMI BDS, total score EAT, total score
P unadjusted
Male (n=71)
Female (n=81)
7.86 (1.79) 29.44 (3.64) 7.98 (6.62) 21.45 (9.60)
8.32 (2.23) 32.36 (5.65) 10.91 (8.40) 27.77 (11.92)
.163 .000 .020 .001
HbA1c: hemoglobin A1c; S.D.: standart deviation.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
S. Çelik et al. / General Hospital Psychiatry xxx (2015) xxx–xxx Table 3 Correlations (n=152).a
Age HbA1c BDS EAT BMI
Age
HbA1c
BDI
EAT
1 −.100 −.038 −.025 .014
−.100 1 .145 −.046 .092
−.038 .145 1 .196a .105
−.025 −.046 .196a 1 .136
BMI .014 .092 .105 .136 1
HbA1c: hemoglobin A1c. a Unadjusted analysis.
An evaluation of the scale values of the patients included in the study in terms of gender revealed that the total BDS scores of female patients was 10.91±8.40, whereas it was 7.98±6.62 in male patients. The depression scores of female patients were significantly higher than those of male patients (P=.020). The total EAT score of female patients was 27.77±11.92, whereas it was 21.45±9.60 in male patients, showing a statistically significant difference (P=.001). The BMI of female patients was significantly higher than that of male patients (Pb .001) (Table 2). In the analyses conducted with the Kruskal–Wallis test, normal-weight (BMI: b25kg/m 2), overweight (BMI: 25–29.9kg/m 2) and obese (BMI: ≥30kg/m2) patients were not different in terms of BDS and EAT scores (PN.05). The depression scores of patients with BED were significantly higher than those of patients without BED (P=.003). The EAT score in patients with BED was 33.25±15.62, whereas it was 24.35±10.91 in patients without BED, the difference being statistically significant (P= .030). No significant difference was found between the HbA1c levels of patients with or without BED (P= .384). No difference was detected between patients with or without BED in terms of dietary compliance (P=1.000, Fisher's exact), treatment compliance (P=.743) or exercise compliance (P=.729) (Table 3). In the correlation analysis, a significant positive correlation was detected between patients' EAT scale scores and BDS scores (r=+0.196, Pb.05) (Table 3). The association between BED and depression was adjusted confounding age, gender, HbA1c and duration of T2DM. After adjusment, the statistical significance did not change (Table 4). 4. Discussion In this study, in which we researched the prevalence of BED in T2DM patients and the correlation between BED and the level of depression and glycemic control, we found that BED is more common in this group than in the general population, i.e., 5.26%. This result confirms the results of previous studies [13,6] that reported the prevalence of BED in T2DM patients as 2.5%–25.6%. Differences in the prevalence are explained through sample characteristics in studies, diagnostic criteria
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applied and country-based differences in prevalence [15]. Allison et al. [17] found the rate of BED among T2DM patients to be 1.4%, and this was explained by the advanced average age (average age: 60) of the study samples. In our study, those diagnosed with BED were younger and more obese than those who were not, but the difference was not statistically significant. Our results support the results of previous studies [28,29] in which it has been reported that there was no difference in terms of age and BMI between T2DM patients with and without BED. Kenardy et al. [30] reported that diabetic patients with BED were younger than those without BED, and they were also diagnosed with diabetes at an earlier age and might have developed diabetes due to the eating disorder. Kenardy et al. [30] related the existence of BED with high BMI. It is still debated whether BED is effective in the development of diabetes or whether diabetes facilitates the development of BED symptoms. Manucci et al. [13] reported that BED increases weight gain and is a risk factor in the development of T2DM. Yannakoulia [15] claimed that the age of onset of T2DM is later than the age of onset of the eating disorder, that diabetes may facilitate the development of the symptoms for BED and that BED is not a simple variable regarding weight. In our study, we verified our second hypothesis that in patients diagnosed with BEDs, the level of depression is higher. Similar results were also reported in previous studies [31,17,32]. It may be concluded that the coexistence of BED in T2DM patients is a situation that requires more extensive psychiatric support. In addition, our findings that T2DM patients show disordered eating attitudes at a rate of 29.6% and that there is a positive correlation between EAT scores and depression scores necessitate the evaluation of disordered eating attitudes in these patients in addition to BED and examination for depressive symptoms. It has been reported that T2DM patients diagnosed with BED show more dietary, exercise and treatment noncompliance than those who are not diagnosed with BED [30]. The fact that BED was diagnosed in only eight individuals in our study restricts from further comment on the relation between BED and dietary, exercise and treatment compliance. Upon testing the third hypothesis of our study, we found that the HbA1c value was not different in T2DM patients with or without BED. This result supports the results of previous studies [6,31,33] that found that BED was unrelated to glycemic control. In a study that evaluated the effect of BED on diabetes control through HbA1c [30], it was conversely found that the influence of BED on diabetes control was moderate. In a study that researched the effect of BED on glycemic control in T2DM patients in Turkey, it was concluded that BED adversely affected glycemic control [29]. The difference in the results may be explained by the fact that the average age of the participants in the study by Canan et al. [29] were younger than the patients in our study, and the majority of them (65.8%) were females. It has been reported that female
Table 4 Comparison of diabetic patients with and without BED. With BED (n=8)
Without BED (n=144)
Age, years (mean±S.D.) Sex Male (n) Female (n) Duration of DM (mean±S.D.) HbA1c (mean±S.D.) BMI (kg/m2, mean±S.D) BDS, total score (mean±S.D.) EAT, total score (mean±S.D.) Diet compliance (n)
50.75±4.97
55.24±9.36
4 4 4.75±1.66 8.72±3.26 33.78±6.78 17.25±11.69 33.25±15.62 3
67 77 6.5±6.4 8.07±1.96 30.84±4.88 9.11±7.28 24.35±10.91 60
Exercise compliance (n) Treatment compliance (n)
4 5
63 98
P unadjusted
Adjusted
.181 .848
– –
.443 .384 .107 .003 .030
– – – .004 .023 –
1.000* .720 .743
– –
S.D.: standart deviation; HbA1c: hemoglobin A1c. * Fischer exact test. Analysis were adjusted acoording to age, gender, duration of DM and HbA1c.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
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S. Çelik et al. / General Hospital Psychiatry xxx (2015) xxx–xxx
gender is implicated in the development of BED in T2DM [11]. Yet, a study conducted in Turkey with a total of 110 DM (34 T1DM and 76 T2DM) patients revealed no differences in the HbA1c levels of patients with or without eating attitude disorders [34]. There are four main limitations of our study: (1) We did not plan this study as multicentral; otherwise, more number of patients might be included. (2) The prevalence of eating disorders and especially BED was not researched in a control group of healthy individuals, because we aimed to research BED in patients with T2DM only, not to compare with the control group. (3) We designed this study according to DSMIV criteria, because when we planned this study, DSM-V criteria were not published yet. Since the number of eating episodes and the period reduced in the new criteria, if we have taken into consideration the DSM-V, we have found opportunity for diagnosing more patients as BED. (4) Since the number of patients with BED was low, which was another limitation of our study, we have proposed further studies including a great number of patients in the future. 5. Conclusion Our study is the first one in Turkey that examined BED in T2DM patients, including level of depression and clinical characteristics related to diabetes (HbA1c levels, BMI, dietary compliance, etc.) in patients diagnosed with and without BED. Our results show a relation between BED in T2DM patients and level of depression. The clinicians who treat diabetes should ask for a psychiatric consultation in cases where they detect disordered eating attitudes and BED, and organize the treatments in a multidisciplinary way by taking into consideration psychopathologies of the patients other than eating disorders. It should also be noted that there is a need for further studies that are multicentered and involve larger samples, which research psychiatric comorbidity and especially eating disorders in T2DM patients. References [1] King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414–31. [2] Shaw JE, Sucre RA, Zimmet PZ. Global estimates for the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4–14. [3] Crow SJ, Keel PK, Kendall D. Eating disorders and insulin-dependent diabetes mellitus. Psychosomatics 1998;39(3):233–43. [4] Bagrıaçık N. Tanı, komplikasyonlara yaklaşım, tedavi konsensus el kitabı. Novo Nordisk diyabet servisi yayınları. İstanbul: Şişli Etfal Tıp Bülteni; 1997. [5] Pouwer F, Beekman AT, Nijpels G, Dekker JM, Snoek FJ, Kostense PJ, et al. Rates and risks for co-morbid depression in patients with type 2 diabetes mellitus: results from a community-based study. Diabetologia 2003;46(7):892–8. [6] Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type 2 diabetes mellitus. Int J Eat Disord 2001;30:222–6. [7] Pibernik-Okanovic M, Peros K, Szabo S, Begic D, Metelko Z. Depression in Croatian type 2 diabetic patients: prevalence and risk factors. A Croatian survey from the European Depression in Diabetes (EDID) Research Consortium. 2005;22(7):942–5. [8] Téllez-Zenteno JF, Cardiel MH. Risk factors associated with depression in patients with type 2 diabetes mellitus. Arch Med Res 2002;33(1):53–60. [9] Eren İ, Erdi Ö, Özcankaya R. Tip II Diabetik Hastalarda Kan Şekeri Kontrolü İle Psikiyatrik Bozuklukların İlişkisi. Türk Psikiyatri Dergisi 2003;14(3):184–91.
[10] Özdemir İ, Hocaoğlu Ç, Koçak M, Ersöz Ö. Tip 2 diyabetes mellituslu hastalarda yaşam kalitesi ve ruhsal belirtiler. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 2011;24:128–38. [11] Pinhas-Hamiel O, Levy-Shraga Y. Eating disorders in adolescents with type 2 and type 1 diabetes. Curr Diab Rep 2013;13(2):289–97. [12] Wonderlich SA, Gordon KH, Mitchell JE, Crosby RD, Engel SG. The validity and clinical utility of binge eating disorder. Int J Eat Disord 2009;42(8):687–705. [13] Mannucci E, Tesi F, Ricca V, Pierazzuoli E, Barciulli E, Moretti S, et al. Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord 2002;26(6):848–53. [14] American Psychiatric Association. DSM-IV — Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994. [15] Yannakoulia M. Eating behavior among type 2 diabetic patients: a poorly recognized aspect in a poorly controlled disease. Rev Diabet Stud 2006;3(1):11–6. [16] Westenhoefer J, Broeckmann P, Munch AK, Pudel V. Cognitive control of eating behaviour and the disinhibition effect. Appetite 1994;23(1):27–41. [17] Allison KC, Crow SJ, Reeves RR, West DS, Foreyt JP, Dilillo VG, et al. Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity (Silver Spring) 2007;15(5):1287–93. [18] Brownstone LM, Bardone-Cone AM, Fitzsimmons-Craft EE, Printz KS, Le Grange D, Mitchell JE. Subjective and objective binge eating in relation to eating disorder symptomatology, negative affect, and personality dimensions. Int J Eat Disord 2013;46(1):66–76. [19] Herpertz S, Albus C, Wagener R, Kocnar M, Wagner R, Henning A, et al. Comorbidity of diabetes and eating disorders. Does diabetes control reflect disturbed eating behavior? Diabetes Care 1998;21(7):1110–6. [20] Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 1979;9:273–9. [21] Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71. [22] Özkürkçigil A, Aydemir Ö, Yıldız M, Esen Danacı A, Köroğlu E. DSM-IV Eksen-I Bozuklukları İçin Yapılandırılmış Klinik Görüşmenin Türkçe'ye Uyarlanması ve Güvenilirlik Çalışması. İlaç Tedavi Dergisi 1999;12(4):233–6. [23] First MB, Spitzer RL, Gibbon M, Williams JBW. Structed Clinical Interview for DSM IV Axis Disorders (SCID-I) Clinical Version. Washington D.C. and London: American Psychiatric Press, Inc; 1997. [24] World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva, Switzerland: World Health Organization; 2000 [Technical report series no. 894]. [25] American Diabetes Association. Standards of Medical Care in Diabetes — 2013. Diabetes Care 2013;36(Suppl. 1):11–66. [26] Erol N, Savasir I. Yeme Tutum Testi: Anoreksia nevroza belirtileri indeksi. Türk Psikoloji Dergisi 1989;23:132–6. [27] Hisli N. Beck Depresyon Envanterinin geçerliliği üzerine bir çalışma. Türk Psikoloji Dergisi 1988;6:118–26. [28] Wilfley D, Berkowitz R, Goebel-Fabbri A, Hirst K, Ievers-Landis C, Lipman TH, et al. Binge eating, mood, and quality of life in youth with type 2 diabetes. Diabetes Care 2011;34:858–60. [29] Canan F, Güngör A, Onder E, Celbek G, Aydın Y, Alcelik A. Tip 2 Diyabet Hastalarında Tıkınırcasına Yeme Bozukluğu ve Glisemik Kontrol Arasındaki İlişki. Turk J Endocrinol Metab 2011;15:26–7. [30] Kenardy J, Mensch M, Bowen K, Green B, Walton J, Dalton M. Disordered eating behaviours in women with type 2 diabetes mellitus. Eat Behav 2001;2(2): 183–92. [31] Wing RR, Marcus MD, Epstein LH, Blair EH, Burton LR. Binge eating in obese patients with type II diabetes. Int J Eat Disord 1989;8:671–9. [32] Morse SA, Ciechanowski PS, Katon WJ, Hirsch IB. Isn't this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes. Diabetes Care 2006;29(8):1800–4. [33] Herpertz S, Albus C, Lichtblau K, Köhle K, Mann K, Senf W. Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study. Int J Eat Disord 2000;28(1):68–77. [34] Ustunsoy S, Altuntaş Y, Karamustafalıoğlu O, Şengül A, Çobanoğlu N. Tip 1 ve Tip 2 Diyabetes Mellitus Hastalarında Yeme Bozuklukları ve Bozulmuş Yeme Davranışı. Düşünen Adam 2008;21(1–4):24–31.
Please cite this article as: Çelik S., et al, Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients, Gen Hosp Psychiatry (2015), http://dx.doi.org/10.1016/j.genhosppsych.2014.11.012
