January 1st, 2014

Program addresses co-occurring eating disorders and diabetes

The American Diabetes Association reports that research suggests eating disorders may be more common among women who also have diabetes than in those who do not. Until recently, no programs existed in New England to address this complex problem; however, in September, Walden Behavioral Care, LLC and the Joslin Diabetes Center teamed up to create the Type I Diabetes Eating Disorder Program.

Stuart Koman, Ph.D., president and CEO of Walden, explains that although Walden has a strong program for eating disorders, the facility needed to add a medical component to better serve patients with co-occurring eating disorders and insulin-dependent diabetes. “We needed a strong medical program so we could hold the patient long enough to provide psychological/psychiatric treatment,” he notes. Walden and Joslin had collaborated previously, but without any formal arrangement, so forming a consultation agreement made good sense.

According to Koman, anorexia presents as one of the most common and debilitating disorders. “Combine anorexia with uncontrolled diabetes and it becomes an extremely problematic situation. The person could develop eye or arterial disease and lose limbs,” he says. “Individuals with diabetes and eating disorders are three times more likely to die.”

Patients with these co-occurring conditions exhibit a severely ingrained behavioral pattern that requires significant effort on the part of nursing to monitor, according to Koman. In some cases, patients attempt to lose weight by skipping or reducing their insulin injections, he adds. “When you have a person with a starving brain who is not taking her insulin, there’s no reasoning and psychotherapy that will do good,” he says. “You have to get the person to medical stability first and then begin psychotherapeutic treatment. Psychiatric medications don’t work the way they should if the person is so thin.”

Young patients, in particular, may miss significant developmental milestones, including bone and brain development, which they will never regain. Osteoporosis, learning disorders and death are possibilities.

In August, Ann E. Goebel-Fabbri, Ph.D., a researcher and clinical psychologist at Joslin, provided on-site training at Walden for nursing staff, counselors and dieticians. “The goal is to bring as many staff into awareness of diabetes basics. Just working with patients and understanding them and their medical condition is important,” she says.

A nurse practitioner from Walden shadowed clinicians in the pediatric, adult medicine, renal and eye units at Joslin this fall. “Other nurse practitioners are in the process of being trained,” explains Goebel-Fabbri. “They will meet with certified diabetes educators to answer their questions. They need to understand the symptoms of Type I diabetes and also learn how to help manage diabetes so they and the patients feel safe.”

Doctors at Joslin provide a treatment plan and a nurse practitioner follows through, explains Goebel-Fabbri.

Although training to date has focused on inpatients and residential care for adolescents from the age of 12 and adults, the two entities hope to broaden the program.

By Phyllis Hanlon

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