Pre-diagnosis binge eating independently associated with insulin use in gestational diabetes — ASN Events
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Pre-diagnosis binge eating independently associated with insulin use in gestational diabetes (#101)

Roslyn A Smith 1 2 , Katrina Tran 3 , Elena Ryan 4 , Zoe Jay 4 , Rebecca White 5 , Sarah Lam 6 , Jessica Barlogie 6 , Stephanie Terry 6 , Claire Harper 1 2 , Caitlin McMaster 7 , Tang Wong 6 8 9 , Vincent Wong 1 9 , David Simmons 3 8 , Robyn A Barnes 6 10
  1. Liverpool Hospital Diabetes and Endocrine Service, Liverpool, NSW
  2. Dietetics Department, Liverpool Hospital, South West Sydney, NSW
  3. Macarthur Diabetes and Endocrine Service, Campbelltown, NSW
  4. Nutrition and Dietetics, School of Health and Society, University of Wollongong, Wollongong, NSW
  5. South Western Sydney Local Health District Mental Health Services, Liverpool, NSW
  6. Diabetes Centre Bankstown-Lidcombe Hospital, Bankstown, NSW
  7. South Western Sydney Allied Health Research Network, Liverpool, NSW
  8. Western Sydney University, Campbelltown, NSW
  9. University of New South Wales, Sydney, NSW
  10. South Western Sydney Local Health District Internal Medicine Clinical Stream, Liverpool, NSW

Background: Women with current or past eating disorders have higher risk of adverse pregnancy outcomes. Binge eating disorder is more common in Type 2 diabetes than in the general population, yet little is known about binge eating in gestational diabetes (GDM).

Aim: To assess whether binge eating before GDM diagnosis is associated with insulin use.

Methods: Binge eating was measured using the Eating Disorder Examination Questionnaire completed by consenting women before GDM education. Objective binge episodes (OBE) were defined as eating an unusually large amount of food with loss of control. The primary outcome was insulin use versus diet‑only management. Associations between OBE frequency and outcomes were examined using t-tests, chi‑square tests, and logistic regression.

Results: Among 89 participants, 72% were of non‑Anglo-Australian ethnicity, 19% had prior GDM and mean (SD) age was 32.1 (5.3) years. Pre‑pregnancy body mass index (ppBMI) distribution was 28% <25.0 kg/m², 67% ≥25.0 kg/m² and 5% unknown. Overall, 25% reported ≥4 OBE, 18% reported 1–3, and 57% reported nil OBE in the preceding 28 days. Rates of ≥4 OBE were similar for ppBMI <25.0 and ≥25.0 kg/m² (25% vs 22%, p=0.741). Gestational weight gain did not differ significantly between ≥4 OBE and nil OBE (median 11.0 vs 10.5 kg; p=0.427).

More women with ≥4 OBE required insulin than nil OBE (72% vs 37%, p=0.009), including basal insulin for fasting hyperglycaemia (72% vs 33%, p=0.003) and bolus insulin for postprandial hyperglycaemia (50% vs 13%, p=0.003). After adjustment for other confounders — the OBE associations persisted: any insulin (OR 5.58, 95% CI 1.49–20.90), basal (OR 6.08, 95% CI 1.62–22.92), and bolus (OR 6.34, 95% CI 1.58–25.54).

Conclusions: Frequent OBE before GDM diagnosis was independently associated with insulin use, possibly reflecting increased caloric and/or carbohydrate intake during binges leading to recurrent postprandial or overnight hyperglycaemia. Despite this, gestational weight gain was similar for frequent verses nil OBE, suggesting possible compensatory behaviours such as dietary restriction. Early screening and management of binge eating may be warranted in GDM care, particularly given the demands of insulin therapy for both patients and clinicians.