101
|
Wisting L, Frøisland DH, Skrivarhaug T, Dahl-Jørgensen K, Rø O. Disturbed eating behavior and omission of insulin in adolescents receiving intensified insulin treatment: a nationwide population-based study. Diabetes Care 2013; 36:3382-7. [PMID: 23963896 PMCID: PMC3816868 DOI: 10.2337/dc13-0431] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish the prevalence of disturbed eating behavior (DEB) and insulin omission among adolescents with type 1 diabetes using intensive insulin treatment in a nationwide population-based study. RESEARCH DESIGN AND METHODS The Diabetes Eating Problem Survey-Revised (DEPS-R) is a diabetes-specific screening tool for DEB. Clinical data and HbA1c were obtained from the Norwegian Childhood Diabetes Registry. RESULTS A total of 770 children and adolescents 11-19 years of age with type 1 diabetes completed the DEPS-R. A total of 27.7% of the females and 8.6% of the males scored above the DEPS-R cutoff. Participants scoring above the cutoff had significantly higher HbA1c (9.2% [77 mmol/mol]; SD, 1.6) than participants scoring below the cutoff (8.4% [68 mmol/mol]; SD, 1.3; P < 0.001). The prevalence of DEB increased significantly with age and weight, from 7.2% in the underweight group to 32.7% in the obese group, and from 8.1% in the youngest age-group (11-13 years) to 38.1% in the oldest age-group (17-19 years). A total of 31.6% of the participants reported insulin restriction and 6.9% reported insulin omission after overeating. Patients reporting insulin restriction had significantly higher HbA1c (9.0% [75 mmol/mol]; SD, 1.7) than nonrestrictors (8.3% [67 mmol/mol]; SD, 1.2; P < 0.001). CONCLUSIONS One-fourth of girls with type 1 diabetes scored above the cutoff for DEB and one-third reported skipping their insulin dose entirely at least occasionally after overeating. Both DEB and insulin restriction were associated with poorer metabolic control, which may increase the risk of serious late diabetes complications.
Collapse
|
102
|
Hanlan ME, Griffith J, Patel N, Jaser SS. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr Diab Rep 2013; 13:10.1007/s11892-013-0418-4. [PMID: 24022608 PMCID: PMC4002640 DOI: 10.1007/s11892-013-0418-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes compared with their peers without diabetes. Eating disorders and disordered eating behaviors-especially insulin omission-are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner.
Collapse
Affiliation(s)
- Margo E. Hanlan
- Preferred Pediatrics, 10600 Spotsylvania Avenue, Fredericksburg, VA, 540-604-9500 Fax: 540-604-9501
| | - Julie Griffith
- Joslin Diabetes Center, Boston, MA, 1 Joslin Place, Boston, MA, 617-732-2603 Fax: 617-309-2451
| | - Niral Patel
- Department of Pediatrics, Vanderbilt University, Nashville, TN, 2200 Children's Way, Nashville, TN, 615-343-6603 Fax: 615-875-7633
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University, Nashville, TN, 2200 Children's Way, Nashville, TN, 615-343-6603 Fax: 615-875-7633
| |
Collapse
|
103
|
Wisting L, Frøisland DH, Skrivarhaug T, Dahl-Jørgensen K, Rø O. Psychometric properties, norms, and factor structure of the diabetes eating problem survey-revised in a large sample of children and adolescents with type 1 diabetes. Diabetes Care 2013; 36:2198-202. [PMID: 23536586 PMCID: PMC3714528 DOI: 10.2337/dc12-2282] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the psychometric properties of the Diabetes Eating Problem Survey-Revised (DEPS-R) in a large sample of young patients with type 1 diabetes, to establish norms, and to validate it against the Eating Attitudes Test-12 (EAT-12). RESEARCH DESIGN AND METHODS A total of 770 children and adolescents aged 11-19 years with type 1 diabetes completed the DEPS-R and the EAT-12. In addition, age- and sex-standardized BMI and HbA1c data were obtained from the Norwegian Childhood Diabetes Registry. In addition to tests of validity, principal axis factoring was conducted to investigate the factor structure of the 16-item DEPS-R. RESULTS The DEPS-R demonstrated satisfactory Cronbach α (0.89) and was significantly correlated with the EAT-12 (0.65; P < 0.01), indicating convergent validity. The mean (SD) DEPS-R scores were 11.0 (10.7) for the total sample and 7.7 (7.4) and 14.2 (2.4) for males and females, respectively. CONCLUSIONS This study replicates and extends previous research demonstrating the psychometric properties of the abbreviated 16-item DEPS-R. Findings support the utility of this important screening tool to identify disturbed eating in young patients with type 1 diabetes.
Collapse
Affiliation(s)
- Line Wisting
- Regional Eating Disorders Service, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | | | | | | | | |
Collapse
|
104
|
Abstract
Diabetic ketoacidosis (DKA) is a serious medical and obstetrical emergency usually occurring in patients with type 1 (insulin-dependent) diabetes mellitus. Although modern management of the patient with diabetes should prevent the occurrence of DKA during pregnancy, this complication still occurs and can result in significant morbidity and mortality for mother and/or fetus. Metabolic changes occurring during pregnancy can predispose a pregnant diabetic to DKA. The diagnosis of DKA can be more challenging during pregnancy as it does not always manifest with the classic presenting symptoms or laboratory findings. In fact, although uncommon, during pregnancy, DKA may develop even in the setting of relative normoglycemia. Prompt diagnosis and management is essential in order to optimize maternal and fetal outcomes. This article will provide the reader with information regarding the pathophysiology underlying DKA complicating pregnancy and will provide practical management guidelines for the diagnosis and management of this condition.
Collapse
Affiliation(s)
- Margarita de Veciana
- Maternal-Fetal Medicine Obstetrics and Gynecology, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 310, Norfolk, VA 23507, USA.
| |
Collapse
|
105
|
Gill GV, Wallymahmed ME, Wallymahmed A, MacFarlane IA, Woodward A. Glycaemic streaming in type 1 diabetes: implications for intervention? PRACTICAL DIABETES 2013. [DOI: 10.1002/pdi.1781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
106
|
|
107
|
Isidro ML, Jorge S. Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis. Acta Diabetol 2013; 50:183-7. [PMID: 21136122 DOI: 10.1007/s00592-010-0243-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/25/2010] [Indexed: 11/25/2022]
Abstract
To evaluate the association between recreational drug use and diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in our area. Retrospective examination of records from a 1,450 bed urban teaching hospital in Spain. All adult admissions for DK or DKA from January 1, 2005, to December 31, 2009 in our hospital were included. Demographic, exploratory (blood pressure, heart rate, respiratory rate), and analytical data (glucose, urea, creatinine, corrected Na(+), K(+), pH, HCO3(-) and HbA1c) at admittance were recorded. In 152 patients, 253 episodes of DK or DKA occurred. Screening for drug use was performed in 40.3% of the events; 20.6% of the episodes (n = 52) were shown to be substance abuse. Cocaine, followed by cannabis and alcohol, was the most frequently involved drug. Poly-substance abuse occurred in 67.3% of them. Comorbidities were present in 11.5 and 39.8% of the cases shown and not shown to be related to drug use (P = 0.00). Seventy percent of the patients who were at least once shown to have consumed drugs, and 15.9% of those who were never shown to have done so, were admitted more than once (P = 0.00). The frequency of recent drug misuse in patients presenting with DK or DKA was high. Substance abuse screening was frequently neglected. Adverse profile, most significantly in readmission to hospital, was found in the patients with positive drug findings. History taking in this context should routinely include questions on substance abuse, and toxicology screening may be worthwhile, particularly in those with the history of frequent readmissions.
Collapse
Affiliation(s)
- María L Isidro
- Endocrine Department, Complexo Hospitalario Universitario A Coruña, As Xubias 84, 15006, A Coruña, Spain.
| | | |
Collapse
|
108
|
d'Emden H, Holden L, McDermott B, Harris M, Gibbons K, Gledhill A, Cotterill A. Disturbed eating behaviours and thoughts in Australian adolescents with type 1 diabetes. J Paediatr Child Health 2013. [PMID: 23199338 DOI: 10.1111/jpc.12014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To describe the presence and type of disturbed eating behaviours and thoughts in a combined male/female Australian sample of adolescents with type 1 diabetes, and examine the association of eating behaviours and thoughts with glycaemic control as evidenced by high glycosylated haemoglobin levels (HbA1c). METHODS In this cross-sectional descriptive study, 124 adolescents aged 13-18 years were invited to complete three self-administered questionnaires. The Youth Eating Disorder Examination Questionnaire (YEDE-Q) and the Eating Disorder Inventory -3 Risk Composite (EDI-3RC) assessed risk for an eating disorder. The third questionnaire, the Strengths and Difficulties Questionnaire (SDQ) assessed emotional and behavioural concerns. Clinical data were collected from the medical records, routine clinic appointments and the adolescent. RESULTS Any disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% vs. 25.9%). Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, although restraint was not evident in males. Insulin manipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use (0.8%) were less common. Regression analysis showed a significant association between HbA1c and more disturbed eating behaviours and thoughts which remained significant when adjusted for confounders. CONCLUSIONS High rates of disturbed eating behaviours and thoughts were seen in this Australian sample of adolescents with type 1 diabetes. High scores on both eating disorder measures were associated with poorer glycaemic control. These results highlight the need to screen for disordered eating in adolescents with type 1 diabetes.
Collapse
Affiliation(s)
- Helen d'Emden
- Queensland Diabetes Centre, Mater Health Services, Brisbane, Queensland, Australia.
| | | | | | | | | | | | | |
Collapse
|
109
|
Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, Heller S. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta-analysis. Diabet Med 2013; 30:189-98. [PMID: 22913589 DOI: 10.1111/j.1464-5491.2012.03771.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS We report a systematic review to determine (1) prevalence of eating problems compared with peers and (2) the association between eating problems and glycaemic control in young adults with Type 1 diabetes. METHOD We conducted a systematic literature search via electronic databases and meta-analysis. Cohen's d (the mean difference score between Type 1 diabetes and comparison groups) was calculated for 13 studies that met inclusion criteria. RESULTS Eating problems [both disordered eating behaviour (39.3 and 32.5%; d = 0.52, 95% CI 0.10-0.94) and eating disorders (7.0 and 2.8%; d = 0.46, 95% CI 0.10-0.81)] were more common in adolescents with Type 1 diabetes compared with peers and both were associated with poorer glycaemic control (d = 0.40, 95% CI 0.17-0.64). In restricted analyses involving measures adapted for diabetes, associations between eating problems and poorer glycaemic control remained (d = 0.54, 95% CI 0.32-0.76). Disordered eating behaviour (51.8 and 48.1%; d = 0.06, 95% CI -0.05 to 0.21) and eating disorders (6.4 and 3.0%; d = 0.43, 95% CI -0.06 to 0.91) were more common in adolescents with Type 1 diabetes compared with peers, but differences were non-significant. CONCLUSIONS Eating problems are common among this age group. Future work in populations with Type 1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended.
Collapse
Affiliation(s)
- V Young
- Department of Psychology, NIHR CLAHRC for South Yorkshire, Medical School, University of Sheffield, Sheffield, UK.
| | | | | | | | | | | | | |
Collapse
|
110
|
Hanna KM. A framework for the youth with type 1 diabetes during the emerging adulthood transition. Nurs Outlook 2012; 60:401-10. [PMID: 22226223 PMCID: PMC3324668 DOI: 10.1016/j.outlook.2011.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 10/03/2011] [Accepted: 10/30/2011] [Indexed: 10/14/2022]
Abstract
Emerging adulthood, a developmental period from late adolescence to the late twenties, is a critical transition for youths with type 1 diabetes. This article proposes a framework for emerging adults with diabetes during this transitional time, integrating theoretical writings on transitions and emerging adulthood with empirical findings from younger adolescents with diabetes, about whom more is known. Key health, developmental, and behavioral outcomes are proposed, as well as key influential personal and environmental characteristics. Influential transitional events for this age group are also discussed relative to these outcomes and to personal and environmental characteristics. This framework provides a guide for longitudinal studies on the transition to young adulthood among emerging adults with type 1 diabetes. Identifying key times and influential factors will provide information for designing future effective interventions to improve glycemic control and quality of life for these youths as they transition to adulthood.
Collapse
Affiliation(s)
- Kathleen M Hanna
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
| |
Collapse
|
111
|
Abstract
Disordered eating behaviors are common in the adolescent population. These behaviors are especially dangerous for young females with type 1 diabetes due to frequent alterations in insulin levels. This article provides an overview of disordered eating in adolescent females with type 1 diabetes, including prevalence and morbidity, insulin omission and associated health outcomes, risk factors, and suggestions for screening and prevention.
Collapse
Affiliation(s)
- Terri L Schmitt
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| |
Collapse
|
112
|
d'Emden H, Holden L, McDermott B, Harris M, Gibbons K, Gledhill A, Cotterill A. Concurrent validity of self-report measures of eating disorders in adolescents with type 1 diabetes. Acta Paediatr 2012; 101:973-8. [PMID: 22591161 DOI: 10.1111/j.1651-2227.2012.02738.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. METHODS In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. RESULTS The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency; Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. CONCLUSION Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines individual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention.
Collapse
Affiliation(s)
- Helen d'Emden
- Queensland Diabetes Centre, Mater Health Services Brisbane, QLD, Australia.
| | | | | | | | | | | | | |
Collapse
|
113
|
Hay PJ, Carriage C. Eating disorder features in indigenous Aboriginal and Torres Strait Islander Australian peoples. BMC Public Health 2012; 12:233. [PMID: 22439684 PMCID: PMC3342121 DOI: 10.1186/1471-2458-12-233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 03/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity and related cardiovascular and metabolic conditions are well recognized problems for Australian Aboriginal and Torres Strait Islander peoples. However, there is a dearth of research on relevant eating disorders (EDs) such as binge eating disorder in these groups. METHODS Data were obtained from interviews of 3047 (in 2005) and 3034 (in 2008) adults who were participants in a randomly selected South Australian household survey of individuals' age > 15 years. The interviewed comprised a general health survey in which ED questions were embedded. Data were weighted according to national census results and comprised key features of ED symptoms. RESULTS In 2005 there were 94 (85 weighted) First Australian respondents, and in 2008 65 (70 weighted). Controlling for secular differences, in 2005 rates of objective binge eating and levels of weight and shape influence on self-evaluation were significantly higher in indigenous compared to non-indigenous participants, but no significant differences were found in ED features in 2008. CONCLUSIONS Whilst results on small numbers must be interpreted with caution, the main finding was consistent over the two samples. For First Australians ED symptoms are at least as frequent as for non-indigenous Australians.
Collapse
Affiliation(s)
- Phillipa J Hay
- School of Medicine, University of Western Sydney, Locked bag 1797, Penrith 2750, NSW, Australia.
| | | |
Collapse
|
114
|
Larrañaga A, Docet MF, García-Mayor RV. Disordered eating behaviors in type 1 diabetic patients. World J Diabetes 2011; 2:189-95. [PMID: 22087355 PMCID: PMC3215768 DOI: 10.4239/wjd.v2.i11.189] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/05/2011] [Accepted: 10/22/2011] [Indexed: 02/05/2023] Open
Abstract
Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.
Collapse
Affiliation(s)
- Alejandra Larrañaga
- Alejandra Larrañaga, Ricardo V García-Mayor, Eating Disorders Unit, University Hospital of Vigo, 36204 Vigo, Spain
| | | | | |
Collapse
|
115
|
Peters A, Laffel L. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care 2011; 34:2477-85. [PMID: 22025785 PMCID: PMC3198284 DOI: 10.2337/dc11-1723] [Citation(s) in RCA: 398] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Anne Peters
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | | | | |
Collapse
|
116
|
Jaser SS, Yates H, Dumser S, Whittemore R. Risky business: risk behaviors in adolescents with type 1 diabetes. DIABETES EDUCATOR 2011; 37:756-64. [PMID: 22002971 DOI: 10.1177/0145721711422610] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this article is to review risk behaviors and their health consequences in adolescents with type 1 diabetes. The existing literature on common risk behaviors in adolescents is examined, with a focus on illicit drug use, alcohol use, smoking, unprotected sexual activity, and disordered eating behaviors. CONCLUSIONS A review of the literature highlights the lack of studies of risk behaviors in this population. Much of what is known comes from studies with adolescents in the general population or from studies of adults with type 1 diabetes. Known risk and protective factors for risk behaviors and health outcomes are noted. Based on these findings, suggestions are provided for diabetes educators and health care providers to assess for and prevent risk behaviors in adolescents with type 1 diabetes. Directions for future research in this population are indicated, including the need to develop and test standardized prevention programs.
Collapse
Affiliation(s)
- Sarah S Jaser
- The Yale University School of Nursing, New Haven, Connecticut (Dr Jaser, Ms Yates, Dr Whittemore)
| | - Heather Yates
- The Yale University School of Nursing, New Haven, Connecticut (Dr Jaser, Ms Yates, Dr Whittemore)
| | - Susan Dumser
- The Children’s Hospital of Philadelphia, Pennsylvania (Ms Dumser)
| | - Robin Whittemore
- The Yale University School of Nursing, New Haven, Connecticut (Dr Jaser, Ms Yates, Dr Whittemore)
| |
Collapse
|
117
|
Leach MJ, Segal L. Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy. BMC Health Serv Res 2011; 11:221. [PMID: 21923953 PMCID: PMC3182893 DOI: 10.1186/1472-6963-11-221] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 09/19/2011] [Indexed: 11/26/2022] Open
Abstract
Background In order for clinical practice guidelines (CPGs) to meet their broad objective of enhancing the quality of care and supporting improved patient outcomes, they must address the needs of diverse patient populations. We set out to explore the patient attributes that are likely to demand a unique approach to the management of chronic disease, and which are crucial if evidence or services planning is to reflect clinic populations. These were incorporated into a new conceptual framework; using diabetes mellitus as an exemplar. Methods The patient attributes that informed the framework were identified from CPGs, the diabetes literature, an expert academic panel, and two cross-disciplinary panels; and agreed upon using a modified nominal group technique. Results Full consensus was reached on twenty-four attributes. These factors fell into one of three themes: (1) type/stage of disease, (2) morbid events, and (3) factors impacting on capacity to self-care. These three themes were incorporated in a convenient way in the workforce evidence-based (WEB) model. Conclusions While biomedical factors are frequently recognised in published clinical practice guidelines, little attention is given to attributes influencing a person's capacity to self-care. Paying explicit attention to predictable threats to effective self-care in clinical practice guidelines, by drawing on the WEB model, may assist in refinements that would address observed disparities in health outcomes across socio-economic groups. The WEB model also provides a framework to inform clinical training, and health services and workforce planning and research; including the assessment of healthcare needs, and the allocation of healthcare resources.
Collapse
Affiliation(s)
- Matthew J Leach
- Health Economics and Social Policy Group, University of South Australia, Adelaide, South Australia.
| | | |
Collapse
|
118
|
|
119
|
Anderson BJ, McKay SV. Barriers to glycemic control in youth with type 1 diabetes and type 2 diabetes. Pediatr Diabetes 2011; 12:197-205. [PMID: 20561243 DOI: 10.1111/j.1399-5448.2010.00667.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
120
|
Wilfley D, Berkowitz R, Goebel-Fabbri A, Hirst K, Ievers-Landis C, Lipman TH, Marcus M, Ng D, Pham T, Saletsky R, Schanuel J, Van Buren D. Binge eating, mood, and quality of life in youth with type 2 diabetes: baseline data from the today study. Diabetes Care 2011; 34:858-60. [PMID: 21357794 PMCID: PMC3064041 DOI: 10.2337/dc10-1704] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The current study examines the prevalence of binge eating and its association with adiposity and psychosocial functioning in a large, diverse sample of youth with type 2 diabetes. RESEARCH DESIGN AND METHODS In the TODAY study, 678 (mean age 14.0 years; 64.9% girls) of the 704 youth randomized to the study completed a self-report measure of eating disorder symptoms and were categorized as nonovereaters, overeaters, subclinical binge eaters, or clinical binge eaters. RESULTS Youth with clinical (6%) and subclinical (20%) levels of binge eating had significantly higher levels and rates of extreme obesity, global eating disorder and depressive symptoms, and impaired quality of life. CONCLUSIONS These findings highlight the importance of evaluating youth with type 2 diabetes for the presence of binge eating. Future research is needed to determine the cumulative effects of disordered eating, obesity, and psychosocial distress on adherence to lifestyle change recommendations and longitudinal response to treatment.
Collapse
|
121
|
Whittemore R, Jaser S, Guo J, Grey M. A conceptual model of childhood adaptation to type 1 diabetes. Nurs Outlook 2011; 58:242-51. [PMID: 20934079 DOI: 10.1016/j.outlook.2010.05.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Indexed: 12/01/2022]
Abstract
The Childhood Adaptation Model to Chronic Illness: Diabetes Mellitus was developed to identify factors that influence childhood adaptation to type 1 diabetes (T1D). Since this model was proposed, considerable research has been completed. The purpose of this article is to update the model on childhood adaptation to T1D using research conducted since the original model was proposed. The framework suggests that, in individuals and families, characteristics such as age and socioeconomic status as well as the individuals' and families' responses (self-management, coping, self-efficacy, family functioning, social competence) influence the level of adaptation; in children with T1D, characteristics such as treatment modality (pump vs injections) and psychosocial responses (depressive symptoms and anxiety) also influence the level of adaptation. Adaptation has both physiologic (metabolic control) and psychosocial (Quality of Life [QOL]) components. This revised model provides greater specificity to the factors that influence adaptation to chronic illness in children. Research and clinical implications are discussed.
Collapse
Affiliation(s)
- Robin Whittemore
- Yale University, School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536-0740, USA.
| | | | | | | |
Collapse
|
122
|
Abstract
Youth with type 1 diabetes are at high risk for psychosocial morbidities. These include depression, disturbed eating behavior, family conflict, poor health-related quality of life, low self-efficacy, and difficulty with medical adherence and metabolic control. A number of prevention interventions have been studied in this group, with the overall goal of improving adaptation and coping skills. This paper reviews the current research aimed at preventing poor outcomes in youth with type 1 diabetes and recommends simple interventions that can be added to clinical encounters. Recommendations for future psychosocial prevention studies are also discussed.
Collapse
Affiliation(s)
- Naomi R Fogel
- Children's Memorial Hospital, 2300 Children's Plaza, Box 54, Chicago, IL 60614, USA.
| | | |
Collapse
|
123
|
Pinhas-Hamiel O, Graph-Barel C, Boyko V, Tzadok M, Lerner-Geva L, Reichman B. Long-term insulin pump treatment in girls with type 1 diabetes and eating disorders--is it feasible? Diabetes Technol Ther 2010; 12:873-8. [PMID: 20879965 DOI: 10.1089/dia.2010.0049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM This study evaluated the feasibility of insulin pump treatment in adolescent girls with type 1 diabetes mellitus (T1DM) and eating disorders (ED). METHODS Sixty-three girls >10 years old were included in the study. Forty-eight were treated with pump (no-ED-pump group); 15 had ED, of whom eight were treated with pump (ED-pump group), and seven were treated with multiple daily injections (MDI) (ED-MDI group). RESULTS Girls in the ED-pump group had higher hemoglobin A1c (HbA1c) compared to those in the no-ED-pump group both before and after pump initiation (P = 0.007). In the ED-pump group, levels 0-6 months after pump initiation were slightly but not significantly lower compared to baseline reference values (8.48% vs. 8.84%, respectively; P = 0.42). In the no-ED-pump group there was a significant decrease in HbA1c level 0-6 months after pump initiation (8.03% vs. 7.67%, respectively; P = 0.004). Thereafter HbA1c levels were not different from baseline reference on both groups. The rate of hypoglycemic episodes was similar in the ED pump and no-ED-pump groups (0.9 vs. 1.0 episodes per 100 patient-years, respectively). Prior to diagnosis of ED, mean HbA1c levels in the ED-pump group and the ED-MDI group were similar: 9.24 ± 1.25% versus 8.47 ± 1.30% (P = 0.51). In the time intervals after the diagnosis of ED, mean HbA1c level of all measurements in the eight girls in the ED-pump group was significantly lower compared with the seven patients in the ED-MDI group: 9.07 ± 1.33% versus 10.40 ± 2.01% (P = 0.04). CONCLUSIONS Treatment with an insulin pump was feasible in girls with T1DM and ED and resulted in significantly lower HbA1c levels compared to the ED-MDI group.
Collapse
|
124
|
Young-Hyman DL, Davis CL. Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification. Diabetes Care 2010; 33:683-9. [PMID: 20190297 PMCID: PMC2827531 DOI: 10.2337/dc08-1077] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Deborah L Young-Hyman
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia, USA.
| | | |
Collapse
|
125
|
Markowitz JT, Butler DA, Volkening LK, Antisdel JE, Anderson BJ, Laffel LMB. Brief screening tool for disordered eating in diabetes: internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes. Diabetes Care 2010; 33:495-500. [PMID: 20032278 PMCID: PMC2827495 DOI: 10.2337/dc09-1890] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To update and validate a diabetes-specific screening tool for disordered eating (the Diabetes Eating Problem Survey [DEPS]) in contemporary youth with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 112 youth with type 1 diabetes, ages 13-19 years, completed the DEPS. Higher scores on the DEPS indicate more disordered eating behaviors. Youth and their parents also completed additional surveys to examine diabetes-specific family conflict, negative affect related to blood glucose monitoring, youth quality of life, and diabetes burden. Clinicians provided data on height, weight, A1C, and insulin dosing. The DEPS was revised into a shorter, updated measure and validated. RESULTS The revised 16-item DEPS (DEPS-R) displayed excellent internal consistency (Cronbach's alpha = 0.86). Construct validity was demonstrated by positive correlations with zBMI (P = 0.01), A1C (P = 0.001), diabetes-specific family conflict (P < 0.005), youth negative affect around blood glucose monitoring (P = 0.001), parental diabetes-specific burden (P = 0.0005), and negative correlations with frequency of blood glucose monitoring (P = 0.03) and quality of life (P < or = 0.002). External validity was confirmed against clinician report of insulin restriction. CONCLUSIONS The DEPS-R is a 16-item diabetes-specific self-report measure of disordered eating that can be completed in <10 min. It demonstrated excellent internal consistency, construct validity, and external validity in this contemporary sample of youth with type 1 diabetes. Future studies should focus on using the DEPS-R to identify high-risk populations for prevention of and early intervention for disordered eating behaviors.
Collapse
Affiliation(s)
- Jessica T Markowitz
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
126
|
Abstract
Critical care nurses must be able to recognize the signs of symptoms of diabulimia-a potentially life-threatening disorder. Skipping insulin is used as a means of weight control in some persons with diabetes, particularly in young women. This article focuses on the assessment, pathophysiology, critical care nursing interventions, and psychosocial initiatives of interest to critical care nurses in the care of patients with diabulimia.
Collapse
|
127
|
Ruddock S, Fosbury J, Smith A, Meadows K, Crown A. Measuring psychological morbidity for diabetes commissioning. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/pdi.1434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
128
|
Affiliation(s)
- Katie Weinger
- From the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, and the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts
| | - Elizabeth A. Beverly
- From the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, and the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts
| |
Collapse
|
129
|
Nakhla M, Daneman D, To T, Paradis G, Guttmann A. Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System. Pediatrics 2009; 124:e1134-41. [PMID: 19933731 DOI: 10.1542/peds.2009-0041] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The goals were (1) to describe rates of diabetes mellitus (DM)-related hospitalizations and retinopathy screening before and after transition to adult care and (2) to test whether different methods of transfer of care were associated with improved outcomes. METHODS In a retrospective cohort study, we included 1507 young adults with DM of >or=5-year duration and tracked these patients until 20 years of age. RESULTS DM-related hospitalization rates increased from 7.6 to 9.5 cases per 100 patient-years in the 2 years after transition to adult care (P = .03). Previous DM-related hospitalizations, lower income, female gender, and living in areas with low physician supply were associated with higher admission rates. With controlling for all other factors, individuals who were transferred to a new allied health care team with no change in physician were 23% less likely (relative risk: 0.23 [95% confidence interval: 0.05-0.79]) to be hospitalized after the transition than were those transferred to a new physician with either a new or no allied health care team. The rates of eye examinations were stable across the transition to adult care (72% vs 70%; P = .06). Female patients, patients with higher income, and patients with previous eye care were more likely to have an eye care visit after transfer. CONCLUSIONS During the transition to adult health care, there is increased risk of DM-related hospitalizations, although this may be attenuated in youths for whom there is physician continuity. Eye care visits were not related to transition; however, rates were below evidence-based guideline recommendations.
Collapse
Affiliation(s)
- Meranda Nakhla
- Division of Endocrinology and Metabolism, Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
130
|
Markowitz JT, Lowe MR, Volkening LK, Laffel LMB. Self-reported history of overweight and its relationship to disordered eating in adolescent girls with Type 1 diabetes. Diabet Med 2009; 26:1165-71. [PMID: 19929996 PMCID: PMC2840636 DOI: 10.1111/j.1464-5491.2009.02844.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Increased body weight and disordered eating attitudes/behaviours are common in adolescent girls with Type 1 diabetes (T1D). Disordered eating increases risks for diabetes-related complications. This study aimed to identify a rapid screening approach for disordered eating attitudes and behaviours in adolescent girls with T1D and to examine the relationship between disordered eating and body weight in this population. METHODS Ninety adolescent girls, aged 12-19 years, provided a self-assessment of weight status. Participants also completed questionnaires to assess attitudes/behaviours toward food and eating, appetitive responsiveness to the food environment, disinhibition in eating and weight history. RESULTS Forty-three per cent of participants reported a history of overweight. Compared with participants who reported never being overweight, those who reported ever being overweight were significantly older, scored significantly higher on all measures of disordered eating attitudes/behaviours (P < or = 0.009) and were 4.8 times more likely to be currently overweight or obese (P < 0.001). Glycated haemoglobin (HbA(1c)) was similar between those who did and did not report ever being overweight. CONCLUSIONS Because of the ill-health effects of disordered eating and the higher rate of overweight in adolescent girls with T1D, effective screening tools are warranted. The single question 'Have you ever been overweight?' may be sufficient as a first question to screen for those at high risk for disordered eating attitudes/behaviours and to provide early intervention and prevention.
Collapse
Affiliation(s)
- J T Markowitz
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, MA 02215, USA.
| | | | | | | |
Collapse
|
131
|
Affiliation(s)
- John M Court
- Department of Endocrinology and Diabetes, Royal children's Hospital, Parkville, Australia
| | | | | | | |
Collapse
|
132
|
Smart C, Aslander-van Vliet E, Waldron S. Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2009; 10 Suppl 12:100-17. [PMID: 19754622 DOI: 10.1111/j.1399-5448.2009.00572.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Carmel Smart
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | | | | |
Collapse
|
133
|
Psychosocial problems in adolescents with type 1 diabetes mellitus. DIABETES & METABOLISM 2009; 35:339-50. [PMID: 19700362 DOI: 10.1016/j.diabet.2009.05.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 05/11/2009] [Accepted: 05/11/2009] [Indexed: 12/11/2022]
Abstract
Adolescents with diabetes are at increased risk of developing psychiatric (10-20%) or eating disorders (8-30%), as well as substance abuse (25-50%), leading to non-compliance with treatment and deterioration of diabetic control. At high risk are female adolescents with family problems and other comorbid disorders. Impaired cognitive function has also been reported among children with diabetes, mainly in boys, and especially in those with early diabetes diagnosis (< 5 years), or with episodes of severe hypoglycaemia or prolonged hyperglycaemia. Type 1 diabetes mellitus contributes to the development of problems in parent-child relationships and employment difficulties, and negatively affects the quality of life. However, insulin pumps appear to improve patients' metabolic control and lifestyle. The contributions of family and friends to the quality of metabolic control and emotional support are also crucial. In addition, the role of the primary-care provider is important in identifying patients at high risk of developing psychosocial disorders and referring them on to health specialists. At high risk are patients in mid-adolescence with comorbid disorders, low socioeconomic status or parental health problems. Multisystem therapy, involving the medical team, school personnel, family and peer group, is also essential. The present review focuses on the prevalence of nutritional and psychosocial problems among adolescents with diabetes, and the risk factors for its development, and emphasizes specific goals in their management and prevention.
Collapse
|
134
|
Goebel-Fabbri AE. Disturbed eating behaviors and eating disorders in type 1 diabetes: clinical significance and treatment recommendations. Curr Diab Rep 2009; 9:133-9. [PMID: 19323958 DOI: 10.1007/s11892-009-0023-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Girls and women with type 1 diabetes have increased rates of disturbed eating behaviors and clinically significant eating disorders than their nondiabetic peers. Type 1 diabetes is strongly associated with several empirically supported eating disorder risk factors (eg, higher body mass index, increased body weight and shape dissatisfaction, low self-esteem and depression, and dietary restraint). It may be that specific aspects of diabetes treatment increase the risk for developing disordered eating. Disturbed eating behaviors and clinical eating disorders predispose women with diabetes to many complex medical risks and increase risk of morbidity and mortality. For this reason, it is critical that diabetes clinicians understand more about eating disorders to improve the likelihood of early risk detection and access to appropriate treatment. This article presents a review of the current scientific literature on eating disturbances in type 1 diabetes and synthesizes the existent findings into recommendations for screening and treatment.
Collapse
Affiliation(s)
- Ann E Goebel-Fabbri
- Behavioral and Mental Health Unit, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA.
| |
Collapse
|
135
|
Ramli M, Hassan AS, Rosnani S. Dissociative episode secondary to hypoglycemic state in anorexia nervosa: a case report. Int J Eat Disord 2009; 42:290-2. [PMID: 19016482 DOI: 10.1002/eat.20596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Hypoglycemic attack had been reported as one of the medical complications in anorexia nervosa. METHOD We present a 25-year-old man who was diagnosed earlier with anorexia nervosa, presented with an episode of dissociative state during which he was caught for shoplifting. RESULTS In the history, he had a few episodes of fainting spells, which are most possibly due to hypoglycemia. There was no evidence to suggest any misdeeds to support that the stealing was intentional. DISCUSSION Hypoglycemic attack may be common in anorexia nervosa, but this is a rare case with medico-legal implication.
Collapse
Affiliation(s)
- Musa Ramli
- Department of Psychiatry, Kulliyyah of Medicine, International Islamic University, Bandar Indera Mahkota, 25200, Kuantan, Pahang Malaysia.
| | | | | |
Collapse
|
136
|
Alice Hsu YY, Chen BH, Huang MC, Lin SJ, Lin MF. Disturbed eating behaviors in Taiwanese adolescents with type 1 diabetes mellitus: a comparative study. Pediatr Diabetes 2009; 10:74-81. [PMID: 18680544 DOI: 10.1111/j.1399-5448.2008.00422.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study aimed to (i) compare disturbed eating behaviors in adolescents with type 1 diabetes mellitus (T1D) with a matched group of adolescents in Taiwan and (ii) examine the relationships of disturbed eating behaviors to body mass index (BMI) and metabolic control among adolescents with T1D. METHODS A cross-sectional study was conducted in southern Taiwan. Seventy-one adolescents with T1D (aged 10-22 yr; 41 females and 29 males) were matched to a group of non-diabetic adolescents. Adolescents completed two self-reported measures of eating behavior, the Bulimic Investigatory Test, Edinburgh and the Eating Attitude Test-26. Metabolic control was assessed by glycosylated hemoglobin A1c levels. RESULTS Both adolescent females and males with T1D had more symptoms of bulimia and bulimic behaviors than their non-diabetic peers. There were no group differences in the proportion of subthreshold eating disorders. BMI and metabolic control were significant factors predicting disturbed eating behaviors. CONCLUSIONS Both adolescent females and males with T1D exhibited a higher level of disturbed eating behaviors than their non-diabetic adolescent counterparts. Preventive programs that address disturbed eating behaviors should be provided for adolescents with T1D, particularly for adolescents with a high BMI and poor metabolic control.
Collapse
Affiliation(s)
- Yu-Yun Alice Hsu
- Department of Nursing, National Cheng Kung University, Taiwan ROC.
| | | | | | | | | |
Collapse
|
137
|
Papadopoulos FC, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry 2009; 194:10-7. [PMID: 19118319 DOI: 10.1192/bjp.bp.108.054742] [Citation(s) in RCA: 267] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anorexia nervosa is a mental disorder with high mortality. AIMS To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors. METHOD Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers. RESULTS The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome. CONCLUSIONS Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.
Collapse
|
138
|
|
139
|
Lawrence JM, Liese AD, Liu L, Dabelea D, Anderson A, Imperatore G, Bell R. Weight-loss practices and weight-related issues among youth with type 1 or type 2 diabetes. Diabetes Care 2008; 31:2251-7. [PMID: 18809623 PMCID: PMC2584173 DOI: 10.2337/dc08-0719] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the weight-loss practices and weight-related issues reported by youth with diabetes, according to sex and diabetes type. RESEARCH DESIGN AND METHODS A total of 1,742 female and 1,615 male youth aged 10-21 years with type 1 or type 2 diabetes completed a SEARCH for Diabetes in Youth study visit during which height, weight, and A1C were measured. A survey assessed weight-related issues and weight-loss practices. RESULTS Although more common in youth with type 2 diabetes, youth with type 1 diabetes also reported weight-related concerns and had elevated BMI. Among youth who had ever tried to lose weight (n = 1,646), healthy weight-loss practices (diet [76.5%] and exercise [94.8%]) were the most common, whereas unhealthy practices (fasting [8.6%], using diet aids [7.5%], vomiting or laxative use [2.3%], and skipping insulin doses [4.2%]) were less common. In sex-specific multivariable models including age, race/ethnicity, diabetes type, BMI category, and glycemic control, obese females and overweight/obese males were more likely to report ever practicing any unhealthy weight-loss practice than normal-weight youth. These practices were associated with poor glycemic control for female but not male subjects. All unhealthy weight-loss practices except fasting were more common in female than in male subjects. Dieting, fasting, and using diet aids were all more common in youth with type 2 diabetes than in those with type 1 diabetes. CONCLUSIONS Given the prevalence of overweight and obesity among youth with type 1 or type 2 diabetes, health care professionals caring for youth with diabetes need to pay particular attention to identifying youth, particularly females, with unhealthy weight-loss practices.
Collapse
Affiliation(s)
- Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
| | | | | | | | | | | | | |
Collapse
|
140
|
Ryan M, Gallanagh J, Livingstone MB, Gaillard C, Ritz P. The prevalence of abnormal eating behaviour in a representative sample of the French diabetic population. DIABETES & METABOLISM 2008; 34:581-6. [PMID: 18922726 DOI: 10.1016/j.diabet.2008.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/05/2008] [Accepted: 05/19/2008] [Indexed: 10/21/2022]
Abstract
AIM To assess the relationship between abnormal eating behaviour (AEB) and diabetes in a sample of French adult patients with type 1 (T1D) and type 2 (T2D) diabetes. METHODS Ninety-four consecutively recruited patients self-completed a series of validated questionnaires. RESULTS Over one-fourth of men with T1D (26%) or T2D (27%) and 11% of female T2D patients reported consistent and pathological overeating or binge-eating during the previous six months. Glycaemic control in these T1D patients was poorer than in T1D patients defined as normal eaters (NORM) (11.9% versus 9.6%), but did not reach statistical significance (P=0.08), and no significant difference was observed in the T2D group (P=0.61) either. T2D patients reported being markedly more restrained when eating than did the T1D patients (P=0.002), and their restraint increased along with their BMI (P<0.001). Patients who overate or binged also reported greater general hunger (P=0.02) and disinhibition (P=0.003) than did the NORM patients. CONCLUSION AEB is present in French diabetic patients at levels that are probably higher than among the general population. These results highlight the need for: (1) greater awareness among diabetes clinicians of the problem; (2) regular screening of diabetic patients for AEB; and (3) adaptation of therapeutic and dietary recommendations for this patient subgroup.
Collapse
Affiliation(s)
- M Ryan
- Pôle de maladies métaboliques et médecine interne, EDN-CHU d'Angers, 4, rue Larrey, 49033 Angers cedex, France
| | | | | | | | | |
Collapse
|
141
|
Tierney S, Deaton C, Whitehead J. Caring for people with type 1 diabetes mellitus engaging in disturbed eating or weight control: a qualitative study of practitioners’ attitudes and practices. J Clin Nurs 2008; 18:384-90. [DOI: 10.1111/j.1365-2702.2008.02434.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
142
|
Olmsted MP, Colton PA, Daneman D, Rydall AC, Rodin GM. Prediction of the onset of disturbed eating behavior in adolescent girls with type 1 diabetes. Diabetes Care 2008; 31:1978-82. [PMID: 18628570 PMCID: PMC2551638 DOI: 10.2337/dc08-0333] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to identify predictors of the onset of disturbed eating behavior (DEB) in adolescent girls with type 1 diabetes. RESEARCH DESIGN AND METHODS In this prospective study, participants completed the Children's Eating Disorder Examination interview and self-report measures at baseline and at four follow-up assessments over 5 years. Participants were 126 girls with type 1 diabetes, aged 9-13 years at baseline. Of the 101 girls who did not have DEB at baseline, 45 developed DEB during the follow-up period; the 38 for whom data were available for the assessment before onset of DEB were compared with 38 age-matched girls who did not develop DEB. DEB was defined as dieting for weight control, binge eating, self-induced vomiting, or the use of diuretics, laxatives, insulin omission, or intense exercise for weight control. RESULTS Logistic regression indicated that a model including BMI percentile, weight and shape concern, global and physical appearance-based self-worth, and depression was significantly associated with DEB onset (chi(2) = 46.0, 5 d.f., P < 0.0001) and accounted for 48.2% of the variance. CONCLUSIONS Even though scores on the measures were within the published normal range, the onset of DEB was predicted by higher depression and weight and shape concerns and lower global and physical appearance-based self-worth as well as higher BMI percentile 1-2 years earlier compared with those not developing DEB. Early interventions focused on helping girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance may have protective value.
Collapse
Affiliation(s)
- Marion P Olmsted
- Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
143
|
Sparud-Lundin C, Ohrn I, Danielson E, Forsander G. Glycaemic control and diabetes care utilization in young adults with Type 1 diabetes. Diabet Med 2008; 25:968-73. [PMID: 18959611 DOI: 10.1111/j.1464-5491.2008.02521.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore how glycaemic control in young adults is related to diabetes care utilization during the transition to adult diabetes care and if these variables differ between males and females. METHODS This is a retrospective, longitudinal design following patients' records from age 18-24 years. Adolescents (n = 104) connected to one paediatric outpatient clinic and referred to six different adult clinics were included. Data were collected regarding gender, age at diagnosis and transfer, yearly glycated haemoglobin (HbA(1c)) and body mass index, severe hypoglycaemia and diabetic ketoacidosis, retinopathy and diabetes care utilization. RESULTS HbA(1c) decreased over time in females (P = 0.004) but not in males. Less than 10% had HbA(1c) in the recommended range during the study period. The decrease in severe hypoglycaemia and diabetic ketoacidosis was not significant. The prevalence of background retinopathy increased from 5 to 29% during the study period (P < 0.001). Mean transfer age was 19.8 years. The youths visited the paediatric clinic more often than the adult clinic (P < 0.001) and females visited adult care more often than males (P = 0.04). There was a steady decrease in the number of visits/year over time (P < 0. 001). Poor glycaemic control was associated with more visits for both males and females (P = 0.005) in adult care. CONCLUSIONS As there was no gender difference in the relation between HbA(1c) and the number of visits in adult diabetes care, the higher frequency of visits in adult care for females cannot be solely explained by their glycaemic control. Gender differences regarding diabetes care utilization should be further explored.
Collapse
Affiliation(s)
- C Sparud-Lundin
- Institute of Health and Care Sciences, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
| | | | | | | |
Collapse
|
144
|
Ackard DM, Vik N, Neumark-Sztainer D, Schmitz KH, Hannan P, Jacobs DR. Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications. Pediatr Diabetes 2008; 9:312-9. [PMID: 18466215 DOI: 10.1111/j.1399-5448.2008.00392.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a population-based sample of youth. SUBJECTS A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT). METHOD Participants completed surveys and anthropometric measurements of height and weight. RESULTS Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes. CONCLUSIONS Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.
Collapse
|
145
|
Giménez M, Lara M, Vidal M, Jansà M, Conget I. Disturbed eating behaviours and glycaemic control in young subjects with Type 1 diabetes transferred from a paediatric to an adult diabetes unit. Diabet Med 2008; 25:884-5. [PMID: 18644079 DOI: 10.1111/j.1464-5491.2008.02478.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
146
|
|
147
|
Affiliation(s)
- John M Court
- Department of Endocrinology and Diabetes, Royal children's Hospital, Parkville, Australia.
| | | | | | | |
Collapse
|
148
|
Abstract
The problem of insulin restriction is an important women's health issue in type 1 diabetes. This behavior is associated with increased rates of diabetes complications and decreased quality of life. Clinical and technological research is greatly needed to improve treatment tools and strategies for this problem. In this commentary, the author describes the scope of the problem of eating disorders and diabetes, as well as offers ideas about ways technology may be applied to help solve this complex problem.
Collapse
Affiliation(s)
- Ann E Goebel-Fabbri
- Joslin Diabetes Center, Harvard Medical School, Harvard, Massachusetts 02215, USA.
| |
Collapse
|
149
|
Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR, Gunderson EP, Herman WH, Hoffman LD, Inturrisi M, Jovanovic LB, Kjos SI, Knopp RH, Montoro MN, Ogata ES, Paramsothy P, Reader DM, Rosenn BM, Thomas AM, Kirkman MS. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 2008; 31:1060-79. [PMID: 18445730 PMCID: PMC2930883 DOI: 10.2337/dc08-9020] [Citation(s) in RCA: 248] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John L Kitzmiller
- Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, California 95128, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
150
|
|