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Night Eating Can Increase Diabetic Complications

Posted: Thursday, August 17, 2006

Night eating is common in diabetic patients and is associated with increased complications.

"Night-eating syndrome is characterized by excessive eating in the evening and nocturnal awakening with ingestion of food," write Shereen A. Morse, MD, from the University of Washington School of Medicine in Seattle, and colleagues. "Psychosocial variables and emotional triggers may be associated with these behaviors. In patients with diabetes, such behaviors may lead to glucose dysregulation and contribute to obesity and complications."

The investigators evaluated 714 tertiary care patients with type 1 and 2 diabetes and determined the proportion of patients reporting eating more than 25% of their daily food intake after regular suppertime. They also screened patients for major depression, childhood maltreatment histories, nonsecure attachment styles, and emotional eating triggers, and they determined whether patients reporting night-eating behaviors had greater psychosocial distress, higher glycated hemoglobin (HbA1c) levels, more obesity, and more diabetes complications than did patients without night-eating behaviors.

Of the 714 patients, 9.7% reported night-eating behaviors. Compared with patients without these behaviors, those with night-eating behaviors were less compliant with diet, exercise, and glucose monitoring and were more likely to be depressed, to report childhood maltreatment histories, to have nonsecure attachment styles, and to report eating in response to anger, sadness, loneliness, worry, and emotional upset.

Compared with patients without night-eating behaviors, those with night-eating behaviors were more likely to be obese (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.5 - 4.5), to have HbA1C values higher than 7% (OR, 2.2; 95% CI, 1.1 - 4.1]) and to have 2 or more diabetes complications (OR, 2.6; 95% CI, 1.5 - 4.5), after adjustment for age, sex, race, and major depression.

"Night-eating behaviors are associated with adverse outcomes in patients with diabetes," the authors write. "Use of clinical screening tools may help identify patients with night-eating behaviors."

"Pharmacotherapeutic aids for sleep disturbance may decrease the opportunities for nocturnal eating in response to emotions," the authors conclude. "We believe that education about diabetes self-care and the interrelationships between self-care behaviors, affect, and diabetes outcomes will provide patients with an essential understanding of the behavioral, psychological, and physiological mechanisms underlying the clinical manifestations of these eating patterns."

Practice Pearls

· The prevalence of night eating syndrome is 9.7% among adults with type 1 or 2 diabetes.
· Night eating symptoms in diabetic patients are associated with poorer HbA1c and diabetes control, obesity, major depression, a history of abuse, and a nonsecure attachment style.

Source: Diabetes In Control: Diabetes Care. 2006;29:1800-1804