Nutrition specifics in type 2 diabetic patients with binge eating disorder and the effects of glucagonlike peptide I receptor agonists

BACKGROUND: Binge eating disorder (BED) is the most prevalent eating disorder manifesting as episodes with higher than usual food intake uncontrolled by patients. Nutritional specifics, their associations with biological and psychological parameters in Type 2 diabetes mellitus (T2DM) with BED have not been studied.

AIM: To identify specific characteristics of nutrition (food choices, food planning, diet barriers [DB]) in T2DM patients with and without BED, their associations with clinical, laboratory, and psychological parameters and their changes over time under treatment of BED.

MATERIAL AND METHODS: T2DM patients with and without BED participated in this cross-sectional study. In those with and without BED, we compared the characteristics of nutritional style, clinical, laboratory and psychological parameters (depression, anxiety/anxiousness, some personality characteristics, including alexithymia, and diabetes-dependent quality of life (Qol). In subsequent prospective open-label interventional part of the study, we evaluated changes of the nutrition characteristics in T2DM patients with BED under treatment with glucagon-like peptide I receptor agonists (GLP1-RA) versus no BED treatment. The univariate analysis was performed at α=0,05, logistic regression at α=0,10.

RESULTS: The study recruited 273 T2DM patients (176 with and 97 without BED). The BED patients ate less frequently than those without: minimal number of daily food intakes 2,6±1,1 and 2,9±0,8, respectively (р=0,010), food intake skipped 1,5±1,8 and 0,8±1,5 weekly (р=0,001). Compared to no-BED patients, those with BED consumed more sweets (р=0,003), “hidden” fats (eggs, р=0,015; nuts, р=0,027), and alcoholic drinks (р=0,004). In the BED group, there were 23 associations between various foods and clinical and laboratory parameters (9 of them indicated favorable and 14 unfavorable food effects). In the non-BED group, 6 associations were found, all them indicating favorable food effects. In both groups, the most significant DB was “difficult to withdraw sweets”. The BED-specific weighted DB were: “difficult to stick to a diet in unexpected situations”, “when I eat more than allowed, I feel bad”, “sometimes I am not allowed to eat being hungry”, and “I would like to eat foods that I should not eat”. Only in the BED group, there were weak but significant correlations between DB numbers/patient and metabolic parameters: НbA1c (r=0,210, р<0,010), serum insulin level (r=0,171, р<0,05), HOMA insulin resistance index (r=0,286, р<0,010), and triglyceride levels (r=0,183, р=0,026). In both groups, DB numbers correlated to higher scores of somatic complaints, alexithymia, depression, psychopathic deviate, paranoia, autism, social introversion, and poorer diabetes-dependent QoL. Logistic regression showed associations of BED to alcoholic intake (odds ratio [OR] 1,03, 95% CI 1,001–1,058, р=0,044), DB domain “limited food diversity” (OR 1,51; 1,172–1,946, р=0,001), food planning (OR 0,154, 0,054–0,442, р=0,001), DB domain “additional food-related costs” (OR 0,49, 0,304–0,792, р=0,004), and high-fiber foods consumption (OR 0,58, 0,324–1,026, р=0,061).

In the second 6-month study period with 66/176 BED patients, 33 of them were prescribed GLP1-RAs and 33 continued their previous therapy. In both groups, food choices remained unchanged qualitatively. Under treatment with GLP1-RA, there was statistically significant (but not clinically meaningful) decrease in DB domains “limited foods choices” and “limited foods diversity”, while in the control group, a decrease in “limited foods choices” score and an increase in “additional food-related costs” were found.

CONCLUSION: Specific characteristics of nutrition in T2DM patients with BED (less regular food intake, higher intake of unhealthy products and higher numbers of DB, compared to those in T2DM without BED) may negatively affect clinical, laboratory and psychological parameters. Three factors related to nutrition style are associated with increased BED risk and three, with lower risk. The results necessitate a personalized dietary approach to T2DM patients with BED, which requires its timely diagnosis made in primary and secondary care. GLP1-RAs exert no clinically valuable effects on the studied nutrition characteristics in BED patients with T2DM.

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