1型糖尿病与进食障碍的临床与心理表型：基于案例短片序列的T1DE表型研究
本研究基于STEADY研究和伦敦T1DE试点服务的基线评估，开发了匿名T1DE案例短片，并从中归纳出三种主要表型：胰岛素遗漏型（40.0%）、限制型（24.3%）和暴食型（35.7%），并建立了临床严重程度分级框架。70名参与者中绝大多数为女性，平均年龄34.5岁，糖尿病病程18.4年，HbA1c为84.8 mmol/mol。该表型分类旨在支持更精准的诊断、严重度分级及个体化治疗路径的开发。
要点
- T1DE可归纳为胰岛素遗漏型、限制型和暴食型三种主要表型及其亚型。
- 严重程度分级将27.1%归为低风险、32.9%为中风险、40.0%为严重临床风险。
- 所有参与者中仅1人未满足ICD-10/DSM-5进食障碍诊断标准，共病情绪障碍常见。
核心结论
- 三种T1DE表型可作为更精准临床诊断和严重度分级的基础。
- 未来将用于开发诊断筛查工具、心理干预和整合治疗照护路径。
研究设计与样本
- 基于STEADY研究和伦敦T1DE试点服务的基线评估，开发匿名T1DE案例短片。
- 通过迭代过程归纳T1DE表型、对案例短片分型并制定临床严重程度分级框架。
- 共纳入70名参与者，94.3%为女性，年龄34.5±10.6岁，糖尿病病程18.4±12.5年，HbA1c 84.8±32.9 mmol/mol（10.2±3.0%）。
主要发现
- 70名参与者中，34人符合其他特定喂养或进食障碍（OSFED）标准，27人符合神经性贪食症，6人符合神经性厌食症，2人符合暴食障碍。
- 超过50%的参与者有情绪障碍，44.3%有焦虑障碍，20.0%有创伤相关障碍。
- 胰岛素遗漏型（diabulimia）T1DE 28人（40.0%），特征为几乎完全遗漏胰岛素以意图减重，含暴食-清除、厌食和循环亚型。
- 限制型T1DE 17人（24.3%），特征为限制食物/碳水化合物，含暴食-清除、厌食和低血糖亚型。
- 暴食型T1DE 25人（35.7%），特征为主观或客观暴食伴或不伴遗漏餐时胰岛素，含暴食-清除、单纯暴食和低血糖亚型。
关键数值与推荐
- 严重程度分级：19例（27.1%）为低临床风险，23例（32.9%）为中等，28例（40.0%）为严重。
- 70名参与者中仅1人未满足ICD-10/DSM-5进食障碍诊断标准。
临床怎么用
- 临床可依据三种T1DE表型（胰岛素遗漏型、限制型、暴食型）及其亚型进行更精准的诊断分型。
- 结合严重程度分级框架（低、中、严重）评估临床风险，以匹配个体化心理干预和整合治疗照护路径。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
AIMS/HYPOTHESIS: Type 1 diabetes and disordered eating (T1DE) is a common, complex comorbidity of type 1 diabetes with high morbidity and mortality risk. T1DE currently lacks a clear definition, diagnostic differentiation into phenotypes and clinical severity grading, which results in exclusion of people with T1DE from accessing appropriate treatments to improve outcomes. METHODS: We developed anonymised T1DE case vignettes from the baseline assessments of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) and the London-T1DE pilot service at King's College Hospital for people with diabetes and severe eating disorder, integrating detailed biomedical and psychiatric data. In an iterative process, phenotypes of T1DE were developed, the T1DE vignettes were sorted into the different phenotypes and a clinical severity grading framework was developed. RESULTS: The 70 participants (94.3% women) were 34.5 ± 10.6 years old with a diabetes duration of 18.4 ± 12.5 years and HbA1c of 84.8 ± 32.9 mmol/mol (10.2 ± 3.0%). All but one fulfilled ICD-10/Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for a formal eating disorder diagnosis, 34 met criteria for other specified feeding or eating disorder, 27 for bulimia nervosa, six for anorexia nervosa and two for binge eating disorder. Over 50% had a mood disorder, 44.3% an anxiety disorder and 20.0% a trauma-related disorder. From the anonymised T1DE vignettes generated, three main T1DE phenotypes with subtypes emerged: insulin-omission (diabulimia) T1DE (28 participants, 40.0%), characterised by near total insulin omission in intention to lose weight, with (binge-)purge, anorectic and cyclical subtypes; restrict T1DE (17, 24.3%), characterised by restriction of food/carbohydrates (with [binge-]purge, anorectic and hypo subtypes); and binge T1DE (25, 35.7%), characterised by subjective or objective binge eating with or without omission of bolus insulin (with binge-purge, binge-only and hypo subtypes). Severity grading categorised 19 cases (27.1%) as 'low', 23 (32.9%) as 'moderate' and 28 (40.0%) as 'severe' clinical risk. CONCLUSIONS/INTERPRETATION: The three T1DE phenotypes will serve as a basis for more precise clinical diagnosis and severity grading and will be used to develop future diagnostic screening tools, improved psychological interventions and integrated treatment care pathways to match the individual clinical presentation and severity in a personalised medicine approach.
引用
- Pillay D, Paul N, Harrison A, et al. Clinical and psychological phenotypes of type 1 diabetes and disordered eating derived from a case vignette series: T1DE phenotypes. Diabetologia. 2026. PMID: 42191876. doi:10.1007/s00125-026-06756-9
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。