Type 1 Diabetes Mellitus and Mortality Risk in Patients with Anorexia Nervosa

To the Editor: The article “A Longitudinal Investigation of Mortality on Anorexia Nervosa and Bulimia Nervosa” in the August 2013 issue (1) did not mention the comorbidity of anorexia nervosa with type 1 diabetes mellitus. However, a 10-year follow-up of 150 female individuals with type 1 diabetes mellitus, 658 female individuals with anorexia nervosa, and 23 individuals with both disorders showed corresponding mortality rates of 2%, 6.5%, and 38%, respectively. Thus, concurrent type 1 diabetes mellitus and anorexia nervosa conveys a five times greater mortality rate than anorexia alone (2). It has been suggested that the increased mortality is driven by weight loss techniques of inactivating insulin or missing insulin doses to create weight loss from ketotic states and hyperglycemia (3). This technique also increases the risk of renal disease and blindness associated with retinopathy.