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Diabulimia: uma revisão do distúrbio alimentar da diabetes mellitus tipo 1
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Abstract(s)
O controlo rigoroso da alimentação em pacientes com diabetes mellitus tipo 1 é crucial
para a boa gestão da glicemia, pode evoluir para um foco excessivo no próprio peso e na
ingestão calórica, insatisfação com a própria imagem corporal e problemas de
autoestima, aumentando o risco de desenvolver perturbações alimentares,
nomeadamente a diabulimia. Esta revisão aborda as principais características da
diabulimia, como rastreio, diagnóstico e tratamento, referindo também outras
informações como a prevalência e os principais obstáculos que esta patologia levanta,
com o objetivo de capacitar e trazer mais atenção para esta doença pouco abordada e
desconhecida por muitos.
A diabulimia é um transtorno alimentar complexo, subdiagnosticado e pouco conhecido.
É caracterizada pela omissão intencional de insulina de modo a controlar o peso em
indivíduos com diabetes mellitus tipo 1, acarretando graves riscos não só para a saúde
psicológica, como também para a saúde física. As consequências médicas desta patologia,
devido ao constante estado de hiperglicemia, podem ser severas e incluem cetoacidose,
danos orgânicos e vasculares a longo prazo e aumento da morbilidade e mortalidade. Aos
distúrbios metabólicos associam-se os impactos psicológicos, como ansiedade,
depressão e isolamento social. A diabulimia tem uma maior prevalência na população
jovem com diabetes mellitus tipo 1, podendo chegar a valores de 40% de incidência,
atingindo em especial as mulheres com diabetes mellitus tipo 1. Esta entidade apresenta
desafios no diagnóstico, não só pelo estigma associado, mas também pelo
desconhecimento dos profissionais de saúde na sua identificação. O diagnóstico é clínico,
isto é, centrado numa história clínica bem elaborada, num indivíduo com mau controlo
glicémico, podendo ser auxiliado pelos valores de hemoglobina glicada. A ferramenta
mais importante para a minimização do impacto da doença é o rastreio precoce
oportuno, realizado através de questionários de rastreio dirigidos. O tratamento assenta
fortemente numa rede de apoio fidedigna, com necessidade de suporte psicológico
adaptado às atitudes, desejos e necessidades do indivíduo. A colaboração interdisciplinar
entre profissionais de saúde e a rede de suporte familiar e social da pessoa com
diabulimia tem grande peso no sucesso do tratamento, sendo por isso de elevada
importância capacitar e educar tanto as pessoas com diabetes como aqueles que as
rodeiam. Não esquecendo que a formação da equipa de profissionais de saúde é
fundamental, não só na identificação da diabulimia, como na sua abordagem e
tratamento. Como tal, é importante aumentar a consciencialização, aprimorar as ferramentas de rastreio e diagnóstico, criar critérios específicos de diagnóstico e
desenvolver novas e melhores intervenções baseadas na evidência, para mitigar os efeitos
devastadores a curto e longo prazo da diabulimia e melhorar os resultados.
The strict control of diet in patients with type 1 diabetes mellitus is crucial for proper blood glucose management. However, it can lead to an excessive focus on body weight and calorie intake, dissatisfaction with body image, and self-esteem issues, increasing the risk of developing eating disorders, particularly diabulimia. This review discusses the main characteristics of diabulimia, including screening, diagnosis, and treatment, while also covering aspects such as prevalence and key challenges associated with this condition, with the goal of raising awareness by shedding light on this underrecognized and poorly understood disorder. Diabulimia is a complex, underdiagnosed, and little-known eating disorder. It is characterized by the intentional omission of insulin to control weight in individuals with type 1 diabetes mellitus, posing serious risks not only to their psychological health but also to physical well-being. The medical consequences of this condition, due to the persistent state of hyperglycemia, can be severe and include ketoacidosis, long-term organ and vascular damage, and increased morbidity and mortality. Alongside metabolic disturbances, psychological impacts such as anxiety, depression, and social isolation are also prevalent. Diabulimia has a higher prevalence among young people with type 1 diabetes mellitus, with incidence rates reaching up to 40%, particularly affecting women with the condition. Diagnosing this disorder presents challenges, not only due to the stigma associated with it but also because healthcare professionals often lack awareness of its identification. Diagnosis is clinical, based on a well-structured medical history in individuals with poor glycemic control, which can be supported by glycated hemoglobin values. The most important tool for minimizing the impact of the disease is timely early screening, carried out through targeted screening questionnaires. Treatment relies heavily on a trustworthy support network, requiring psychological assistance tailored to the individual's attitudes, desires, and needs. The success of treatment is significantly influenced by interdisciplinary collaboration between healthcare professionals and the patient’s family and social support network. Therefore, it is crucial to educate and empower both individuals with diabetes and those around them. Additionally, the training of healthcare teams is fundamental, not only for identifying diabulimia but also for effectively addressing and treating it. As such, increasing awareness, improving screening and diagnostic tools, establishing specific diagnostic criteria, and developing new and better evidence-based interventions are essential steps to mitigate the devastating short- and long-term effects of diabulimia and improve patient outcomes.
The strict control of diet in patients with type 1 diabetes mellitus is crucial for proper blood glucose management. However, it can lead to an excessive focus on body weight and calorie intake, dissatisfaction with body image, and self-esteem issues, increasing the risk of developing eating disorders, particularly diabulimia. This review discusses the main characteristics of diabulimia, including screening, diagnosis, and treatment, while also covering aspects such as prevalence and key challenges associated with this condition, with the goal of raising awareness by shedding light on this underrecognized and poorly understood disorder. Diabulimia is a complex, underdiagnosed, and little-known eating disorder. It is characterized by the intentional omission of insulin to control weight in individuals with type 1 diabetes mellitus, posing serious risks not only to their psychological health but also to physical well-being. The medical consequences of this condition, due to the persistent state of hyperglycemia, can be severe and include ketoacidosis, long-term organ and vascular damage, and increased morbidity and mortality. Alongside metabolic disturbances, psychological impacts such as anxiety, depression, and social isolation are also prevalent. Diabulimia has a higher prevalence among young people with type 1 diabetes mellitus, with incidence rates reaching up to 40%, particularly affecting women with the condition. Diagnosing this disorder presents challenges, not only due to the stigma associated with it but also because healthcare professionals often lack awareness of its identification. Diagnosis is clinical, based on a well-structured medical history in individuals with poor glycemic control, which can be supported by glycated hemoglobin values. The most important tool for minimizing the impact of the disease is timely early screening, carried out through targeted screening questionnaires. Treatment relies heavily on a trustworthy support network, requiring psychological assistance tailored to the individual's attitudes, desires, and needs. The success of treatment is significantly influenced by interdisciplinary collaboration between healthcare professionals and the patient’s family and social support network. Therefore, it is crucial to educate and empower both individuals with diabetes and those around them. Additionally, the training of healthcare teams is fundamental, not only for identifying diabulimia but also for effectively addressing and treating it. As such, increasing awareness, improving screening and diagnostic tools, establishing specific diagnostic criteria, and developing new and better evidence-based interventions are essential steps to mitigate the devastating short- and long-term effects of diabulimia and improve patient outcomes.
Description
Keywords
Bulimia Diabetes Mellitus Tipo 1 Diabulimia Distúrbio Alimentar Omissão de Insulina