diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12818diaendo-12818Research ArticleКлинический случайCase reportКлинический случай сочетания сахарного диабета 1 типа и расстройства пищевого поведения во время беременностиThe combination of type 1 diabetes and eating disorder during pregnancyhttps://orcid.org/0000-0001-6628-2352ГольдшмидА. Е.GoldshmidA. E.

Гольдшмид Анна Ефимовна

Researcher ID: AAL-6672-2021; eLibrary SPIN: 9985-2541

119435, Москва, ул. Погодинская, д. 1с1

Anna E. Goldshmid, MD

Researcher ID: AAL-6672-2021; eLibrary SPIN: 9985-2541

1/1 Pogodinskaya street, 119435 Moscow

goldshmid_a_e@staff.sechenov.ruhttps://orcid.org/0000-0002-0205-6767БалакшинаН. А.BalakshinaN. A.

Балакшина Нина Александровна, клинический ординатор

Researcher ID: ABA-4135-2021

Москва

Nina A. Balakshina, clinical resident

Researcher ID: ABA-4135-2021

Moscow

dr.balakshina@mail.ruhttps://orcid.org/0000-0003-1848-8721АмосоваМ. В.AmosovaM. V.

Амосова Мария Вадимовна, к.м.н.

Researcher ID: AAP-1967-2021; eLibrary SPIN: 4780-9783

Москва

Maria V. Amosova, MD, PhD

Researcher ID: AAP-1967-2021; eLibrary SPIN: 4780-9783

Moscow

Amosova_m_v@staff.sechenov.ruhttps://orcid.org/0000-0003-2147-3061ПолубояриноваИ. В.PoluboyarinovaI. V.

Полубояринова Ирина Владимировна, к.м.н.

Researcher ID: AAL-6684-2021; eLibrary SPIN: 2571-2900

Москва

Irina V. Poluboyarinova, MD, PhD

Researcher ID: AAL-6684-2021; eLibrary SPIN: 2571-2900

Moscow

Poluboyarinova_i_v@staff.sechenov.ruhttps://orcid.org/0000-0002-3026-6315ФадеевВ. В.FadeevV. V.

Фадеев Валентин Викторович, д.м.н., профессор

Researcher ID: C-3017-2017; eLibrary SPIN: 6825-8417

Москва

Valentin V. Fadeev, MD, PhD, Professor

Researcher ID: C-3017-2017; eLibrary SPIN: 6825-8417

Moscow

walfad@mail.ruПервый Московский государственный медицинский университет имени И. М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202228122022256570575Copyright © Гольдшмид А.Е., Балакшина Н.А., Амосова М.В., Полубояринова И.В., Фадеев В.В., 20232023Гольдшмид А.Е., Балакшина Н.А., Амосова М.В., Полубояринова И.В., Фадеев В.В.Goldshmid A.E., Balakshina N.A., Amosova M.V., Poluboyarinova I.V., Fadeev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12818

Проблема нарушений пищевого поведения в настоящее время занимает особое место в медицине. Нервная булимия — одна из основных форм нарушений пищевого поведения, характеризующаяся трудностью лечения, длительным, рецидивирующим течением. Расстройства пищевого поведения часто встречаются у пациентов с сахарным диабетом 1 типа (СД1), особенно у девочек в подростковом возрасте.

В данной статье мы представляем клинический случай пациентки с СД1, нервной булимией, развившейся до манифестации СД1 и прогрессирующей на его фоне.

Пациентка чрезмерно озабочена контролем массы тела, специально ограничивала прием углеводов, принудительно вызывала рвоту. Во время беременности неоднократно выявлялась кетонурия («голодные кетоны»). Минимальный вес 36 кг (ИМТ 15,2 кг/м2). Особый интерес представляет течение беременности у этой пациентки, закончившейся антенатальной гибелью, поскольку ограничения углеводсодержащей пищи и длительное нахождение в состоянии кетоза могли привести к развитию патологии беременности. В результате обследования у пациентки также были выявлены множественные осложнения сахарного диабета и рекуррентное депрессивное расстройство, что требует дальнейшего совместного наблюдения эндокринолога и психиатра.

Сочетание СД1 и расстройства пищевого поведения у беременной пациентки не позволяет отнести данный случай к типичному течению заболевания.

The problem of eating disorders currently holds a special place in clinical practice. Bulimia nervosa is one of the main forms of eating disorders, characterized by the difficulty in its treatment and a long, recurrent course. Eating disorders are common in patients with type 1 diabetes mellitus (T1D), especially in adolescent girls.

In this article, we present a clinical case of a patient with T1D and bulimia nervosa, which developed before the manifestation of T1D and progressed against its background. The patient is overly concerned with controlling body weight, specifically restricted the intake of carbohydrates, forcibly caused vomiting. During pregnancy fasting ketonuria («low-carb ketone») was repeatedly detected. The minimum weight was 37 kg (BMI 15.2 kg/m2). Particular interest of this case is the course of pregnancy, which ended in the antenatal death. The possible cause could be the restriction on carbohydrate food and prolonged stay in ketosis, that might lead to the development of pregnancy pathology. Additional examination also revealed multiple complications of diabetes and recurrent depressive disorder, which requires conjoint monitoring by an endocrinologist and a psychiatrist.

Combination of T1D and eating disorder in a pregnant patient should be considered as an atypical course of the disease.

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The authors declare that there are no conflicts of interest present.