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Özbey H, Bayat M, Topal T, Hatipoğlu N. Eating Disorders and Sleep Disturbance as Determinants of Metabolic Control in Adolescents with Type 1 Diabetes. Compr Child Adolesc Nurs 2024; 47:131-140. [PMID: 38922698 DOI: 10.1080/24694193.2024.2356846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
This cross-sectional study examined the effect of sleep disturbance and eating disorders on metabolic control in adolescents with Type 1 Diabetes. The study was conducted with adolescents with T1DM treated at a university hospital in Turkey between October 2023 and January 2024. The study sample consisted of 120 adolescents with T1DM between the ages of 10-18. Data were collected online using the Adolescent Information Form, Dutch Eating Behavior Questionnaire (DEBQ), and DSM-5 Sleep Disorder Scale (SDS). Mean, percentage, and regression analyses were used to analyze the data. Ethics committee, institutional permission and written permission from the adolescents with Type 1 Diabetes and their parents were obtained for the study. In the current study, sleep disturbance and eating disorders explained 38.5% and 40.2% of HbA1c, respectively, and were found to have a significant effect (respectively: F = 73.737, p ≤ .001; F = 19.353, p ≤ .001). This study provides evidence that eating disorders and sleep disturbance explain approximately half of HbA1c. The results of the study revealed that sleep disturbance and eating disorders were significant predictors of metabolic control in adolescents with type 1 diabetes.
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Affiliation(s)
- Harun Özbey
- Department of Pediatric Nursing, Faculty of Health Science, Erciyes University, Kayseri, Turkey
| | - Meral Bayat
- Department of Pediatric Nursing, Faculty of Health Science, Erciyes University, Kayseri, Turkey
| | - Tolga Topal
- Faculty of Health Science, Erciyes University, Kayseri, Turkey
| | - Nihal Hatipoğlu
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Propper-Lewinsohn T, Elran-Barak R, Gillon-Keren M, Yackobovitch-Gavan M, Liberman A, Phillip M, Shalitin S. Disordered Eating Behaviors Among Adolescents and Young Adults with Type 1 Diabetes Treated with Insulin Pumps and Hybrid Closed-Loop Systems. Diabetes Technol Ther 2024; 26:229-237. [PMID: 38090768 DOI: 10.1089/dia.2023.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Background and Aims: Disordered eating behaviors (DEB) are more common among individuals with type 1 diabetes (T1D) compared to those without, and for insulin pump users may be associated with higher hemoglobin A1c (HbA1c). We investigated DEB risk factors among insulin pump-treated individuals with T1D and clinical characteristics of hybrid closed-loop (HCL) systems' users by DEB level. Methods: An observational, cross-sectional study of 167 insulin pump-treated individuals with T1D, 13-21 years of age. Data were obtained from patients' medical charts with additional self-reported questionnaires, including assessment of DEB. Results: DEB were found in 71 (42.5%) individuals, and positively associated with female sex (β = 2.98 [standard error (SE) = 1.31], P = 0.025), body mass index (BMI)-Z-score (β = 2.12 [SE = 0.64], P = 0.001), HbA1c (β = 1.40 [SE = 0.45], P = 0.02), and higher rate of pump discontinuation (β = 4.48 [SE = 1.99], P = 0.026). The use of HCL systems compared to insulin pumps was associated with higher BMI-Z-score (odds ratio [OR]: 3.46 [95% confidence interval, CI: 1.52-7.87], P = 0.003) and tendency to lower HbA1c level (OR: 0.44 [95% CI: 0.18-1.09], P = 0.078) among individuals without DEB, and with lower HbA1c level (OR: 0.29 [95% CI: 0.10-0.83], P = 0.022) and higher socioeconomic status (OR: 1.73 [95% CI: 1.09-2.74], P = 0.020) among individuals with DEB. Conclusions: DEB are common among individuals with T1D treated with insulin pumps and are associated with higher HbA1c levels. Among T1D individuals with DEB, HCL system use is associated with lower HbA1c compared to insulin pump treatment. Our findings highlight the importance of regular screening for DEB and its risk factors to improve pump treatment and diabetes management. Moreover, individuals with DEB using HCL systems may benefit from reduced HbA1c levels.
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Affiliation(s)
- Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Niemelä PE, Leppänen HA, Voutilainen A, Möykkynen EM, Virtanen KA, Ruusunen AA, Rintamäki RM. Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis. Eat Behav 2024; 53:101863. [PMID: 38452627 DOI: 10.1016/j.eatbeh.2024.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
AIMS To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms. METHODS We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission. RESULTS A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21-0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24-0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ2 = 85.83, df = 8, p < .0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26-0.34) vs. 18 % (95 % Cl 0.14-0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13-0.33). CONCLUSIONS Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates.
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Affiliation(s)
- Pia E Niemelä
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Hanna A Leppänen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Ari Voutilainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Essi M Möykkynen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Kirsi A Virtanen
- Faculty of Medicine, Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Anu A Ruusunen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland; IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Reeta M Rintamäki
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
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South CA, Talbo MK, Roy-Fleming A, Peters TM, Nielsen DE, Iceta S, Brazeau AS. Does Insulin Delivery Technology Change Our Relationship with Foods? A Scoping Review. Diabetes Technol Ther 2024; 26:136-145. [PMID: 38032855 DOI: 10.1089/dia.2023.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Introduction: Automated insulin delivery (AID) systems reduce burden and improve glycemic management for people with type 1 diabetes (PwT1D) by automatically adjusting insulin as a response to measured glucose levels. There is a lack of evidence on AID and nutrition variables such as dietary intake, eating behaviors, and disordered eating. Objectives: This scoping review aims to provide a summary of the literature regarding AID and nutrition variables and to identify gaps that require further investigation. Methods: Two researchers conducted a blinded search of Medline (OVID) and PubMed for studies, including AID use (compared to non-AID use) and nutrition variables. Studies from January 2000 to July 2023 were included, as were PwT1D of all ages. Results: A total of 3132 articles were screened for appropriateness. After exclusions, 7 studies were included (2017-2023): 4 qualitative, 1 crossover, 1 randomized controlled, and 1 observational. Studies included adolescents (n = 1), adults (n = 3) or both (n = 2), and all ages (n = 1). In quantitative studies, AID was associated with lower eating distress (-0.43 ± 0.12, P = 0.004) and higher quality of life (3.1, 95% confidence interval [CI]: 0.8-5.4, P = 0.01), but not grams of carbohydrates at meals (1.0; 95% CI: -0.7 to 3.0; P = 0.24) and snacks (0.004; 95% CI: -0.8 to 0.8; P = 0.99) compared to non-AID use. In qualitative studies, AID increased the frequency and portions of food intake and led to less dietary control from parents. AID users reported eating foods higher in energy density. PwT1D were less worried about achieving accurate carbohydrate counting (CC) when using AID. Conclusions: AID use appears to influence eating behaviors, dietary patterns, and CC, although evidence was limited. AID may reduce food management burden due to the perception that AID can correct for CC inaccuracy. Significance: Further research needs to determine if AID allows for simplification of CC and improves eating behaviors while maintaining glycemic stability.
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Affiliation(s)
| | - Meryem K Talbo
- School of Human Nutrition, McGill University, Montreal, Canada
| | | | - Tricia M Peters
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, Canada
- Division of Endocrinology, Department of Medicine, The Jewish General Hospital, McGill University, Montreal, Canada
| | - Daiva E Nielsen
- School of Human Nutrition, McGill University, Montreal, Canada
| | - Sylvain Iceta
- Research Center of the Quebec Heart and Lung Institute, Quebec, Canada
- Department of Psychiatry and Neurosciences, Laval University, Quebec, Canada
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Tran T, Igudesman D, Burger K, Crandell J, Maahs DM, Seid M, Mayer-Davis EJ. Eating behaviors and estimated body fat percentage among adolescents with type 1 diabetes. Diabetes Res Clin Pract 2024; 207:111070. [PMID: 38142747 PMCID: PMC10922665 DOI: 10.1016/j.diabres.2023.111070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
AIMS Estimate associations between select eating behaviors and estimated body fat percentage (eBFP) and explore effect modification by sex among adolescents with type 1 diabetes (T1D). METHODS This analysis included 257 adolescents (mean age 14.9 ± 1.14 years; 49.8 % female) with baseline hemoglobin A1c (HbA1c) between 8 and 13 % (64 mmol/mol-119 mmol/mol) from a randomized trial designed to improve glycemia. Eating behaviors and eBFP were determined from surveys and validated equations respectively. Linear mixed models were used to estimate associations. Effect modification was assessed via stratified plots, stratified associations, and interaction terms. RESULTS Disordered eating, dietary restraint, and eBFP were significantly higher among females while external eating was higher among males. Disordered eating (β: 0.49, 95 %CI: 0.24, 0.73, p = 0.0001) and restraint (β: 1.11, 95 %CI: 0.29, 1.92, p = 0.0081) were positively associated with eBFP while external eating was not (β: -0.19, 95 %CI: -0.470, 0.096, p = 0.20). Interactions with sex were not significant (p-value range: 0.28-0.64). CONCLUSION Disordered eating and dietary restraint were positively associated with eBFP, highlighting the potential salience of these eating behaviors to cardiometabolic risk for both female and male adolescents. Prospective studies should investigate whether these eating behaviors predict eBFP longitudinally to inform obesity prevention strategies in T1D.
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Affiliation(s)
- Thanh Tran
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Daria Igudesman
- Translational Research Institute, AdventHealth, Orlando, FL, USA.
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jamie Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA.
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Kara A, Gerçek HG, Özkan Y, Çelikkol Sadıç Ç, Koca SB. Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study. J Pediatr Endocrinol Metab 2023; 36:957-965. [PMID: 37725202 DOI: 10.1515/jpem-2023-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Type 1 diabetes (T1D) causes psychological distress, negatively impacting normal childhood activities. Depression, anxiety disorders, and eating problems are commonly observed in this population. METHODS The study population consisted of 40 adolescents (22 females and 18 males) who had been diagnosed with T1D and 41 healthy adolescents (21 females and 20 males). The aim of this study was to compare adolescents with T1D to healthy controls in terms of depression, anxiety, and eating problems and subsequently examine the T1D group in relation to the risk of diabetes-specific eating disorders. Eating Attitudes Test (EAT-40), Revised Children's Anxiety and Depression Scale (RCADS), and Diabetes Eating Problem Survey - Revised (DEPS-R) scales were used to compare the case and control groups. RESULTS The case group exhibited significantly higher scores in EAT-40 total score, RCADS parent form major depressive disorder (MDD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD), total anxiety score, total scale scores, RCADS child form MDD, PD, and total scale scores compared to the control group. Individuals at high risk of diabetes-specific eating disorder within the case group demonstrated significantly higher RCADS (child and parent form) MDD scores and RCADS parent form separation anxiety (SA) and total scale scores. Binary logistic regression analysis revealed that the RCADS parent form total scale score could predict DEPS-R. CONCLUSIONS Routine screening of children and adolescents diagnosed with T1D for depression, anxiety, and eating disorder risk may facilitate early detection of possible psychopathologies, allowing for early intervention to address factors that may disrupt treatment adherence. Further longitudinal studies with larger samples are needed to investigate psychopathologies, particularly eating disorders, in children and adolescents with T1D.
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Affiliation(s)
- Aziz Kara
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Hacer Gizem Gerçek
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Yekta Özkan
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Çağla Çelikkol Sadıç
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Serkan Bilge Koca
- Department of Pediatric Endocrinology, University of Health Sciences, Kayseri City Hospital, Kayseri, Türkiye
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Troncone A, Affuso G, Cascella C, Chianese A, Zanfardino A, Iafusco D. Prevalence and Multidimensional Model of Disordered Eating in Youths With Type 1 Diabetes: Results From a Nationwide Population-Based Study. J Pediatr Psychol 2023; 48:731-739. [PMID: 36921286 DOI: 10.1093/jpepsy/jsad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE The aim of this study was to report nationwide data of the prevalence of disordered eating behaviors (DEBs) in adolescents with type 1 diabetes (T1D) and to evaluate a multidimensional model of eating problems, analyzing how psychopathological problems are associated with DEBs and with metabolic control. METHODS This study was carried out using a cross-sectional design with a sample of 1,562 patients with T1D (812 male), aged 11-19 years. Participants were recruited from multiple pediatric diabetes centers (N = 30) located in northern, central, and southern Italy, and they individually completed the Diabetes Eating Problem Survey-Revised (DEPS-r) and the Youth Self-Report (YSR). Sociodemographic and clinical data were also gathered. Multiple-group structural equation modeling was used to investigate the relationships between internalizing/externalizing symptoms, DEBs, and glycosylated hemoglobin (HbA1c) values. RESULTS A total of 29.7% of the participants reported DEBs (DEPS-r scores ≥20), 42.4% reported insulin manipulation (IM). The prevalence of DEBs was higher for female participants (p ≤ .001). The model explains 37% of the variance in disordered eating, 12% in IM, and 21% in HbA1c values. Body mass index, externalizing symptoms, and internalizing symptoms were significantly and positively associated with DEBs, which in turn were significantly and positively associated with HbA1c values (all p ≤ .001). Externalizing (p ≤ .001) and internalizing (p ≤ .01) symptoms were also directly associated with HbA1c values. CONCLUSION Given the relevant prevalence of DEBs, their significant positive association with psychopathological symptoms, and their relationship with worse diabetes outcomes, regular psychological screening and support is needed to ensure the best care of adolescents with T1D.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | - Gaetana Affuso
- Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | | | - Angela Zanfardino
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Italy
| | - Dario Iafusco
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Italy
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Wetter SE, Driscoll KA. Commentary: From Recommendations to Reality: Assessment and Treatment of Adolescents With Type 1 Diabetes and Disordered Eating Behaviors. J Pediatr Psychol 2023; 48:740-742. [PMID: 37330674 DOI: 10.1093/jpepsy/jsad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023] Open
Affiliation(s)
- Sara E Wetter
- Department of Clinical and Health Psychology, University of Florida, USA
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9
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Zhou M, Wang H, Yu J, Luo D, Zhu M, Zhang M, Xu J, Yang T. Diabetes distress and disordered eating behaviors in youth with type 1 diabetes: the mediating role of self-regulatory fatigue and the moderating role of resilience. J Eat Disord 2023; 11:123. [PMID: 37481574 PMCID: PMC10362565 DOI: 10.1186/s40337-023-00838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/28/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Despite previous research on the association between diabetes distress and disordered eating behaviors (DEBs) among youth with type 1 diabetes (T1D), there is a lack of understanding regarding the underlying mechanisms. This study aimed to investigate the relationships between diabetes distress and DEBs, specifically examining whether self-regulatory fatigue mediated the relationship and whether resilience moderated this mediation. METHODS A cross-sectional study was performed among youth with T1D recruited from two diabetes centers in Nanjing, China. Measurement instruments included the problem areas in the diabetes-5 scale, the diabetes strengths and resilience measure for adolescents, the self-regulatory fatigue scale, and the Chinese version of diabetes eating problem survey-revised. Mediation and moderated mediation analyses were conducted. RESULTS A total of 185 youths with T1D were involved in the current study. The results indicated that diabetes distress positively predicted DEBs. Self-regulatory fatigue partially mediated the association between diabetes distress and DEBs, accounting for 50.88% of the overall effect. Additionally, the pathway from self-regulatory fatigue to DEBs was moderated by resilience. CONCLUSION The current study examined whether self-regulatory fatigue mediated the relationship between diabetes distress and DEBs and whether resilience moderated the connection between self-regulatory fatigue and DEBs. These findings add to the theoretical basis of how diabetes distress influences DEBs and help guide the incorporation of diabetes distress, self-regulatory fatigue, and resilience into DEBs reduction programs for youth with T1D.
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Affiliation(s)
- Meijing Zhou
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jian Yu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, 210029, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Mei Zhang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jingjing Xu
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
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10
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Goddard G, Oxlad M, Turnbull D. The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review. J Diabetes Metab Disord 2023; 22:13-34. [PMID: 37255778 PMCID: PMC10225459 DOI: 10.1007/s40200-022-01151-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
Background Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males' misuse of insulin for weight and/or shape control. Methods A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021. Results A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies). Conclusion Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01151-8.
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Affiliation(s)
- Georgia Goddard
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
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Yafei S, Hummadi A, Badedi M, Darraj H, Khawaji A, Alzughbi T, Abutaleb R, Alhagawy AJ, Alnami A, Kudam B, Bahsan F, Kariri M, Adawi M, Daghriri M, Hassan R, Soeid M, Alzughbi N. Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020345. [PMID: 36837546 PMCID: PMC9961766 DOI: 10.3390/medicina59020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
Background and Objectives: The prevalence of disordered eating behaviors (DEBs) in type 1 diabetes (T1D) has been studied globally; however, data from Saudi Arabia and Arab-speaking countries are scarce. This study aimed to measure the prevalence of DEBs and associated clinical characteristics in adolescents and young adults with T1D, and the impact of DEBs on glycemic parameters. Materials and Methods: A total of 265 adolescents and young adults with T1D (aged 12-25 years) were recruited randomly from the registry at the Jazan Endocrinology and Diabetes Center, Saudi Arabia. Participants completed the Diabetes Eating Problem Survey-Revised (DEPS-R) questionnaire. Other measures included hemoglobin A1c (HbA1c) in addition to sociodemographic, anthropometric, and clinical data. Results: The prevalence of DEBs among T1D was 27.2%. Females (32.5%) had a higher proportion of DEBs than males (18.6%) (p = 0.01). About 27% of the participants reported insulin restriction. A history of hospital admission in the previous 6 months due to DKA and frequent hypoglycemia was more frequently reported in T1D participants with DEBs compared to those without (p = 0.03). Participants with DEBs had higher HbA1c and higher BMI compared to those without DEBs. Conclusions: Adolescents and young adults with T1D with disordered eating and insulin restriction have higher glycated hemoglobin, and are at higher risk of DKA. Routine screening for DEBs should be an essential element in diabetes care, especially among highly vulnerable groups.
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Affiliation(s)
- Saeed Yafei
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
- Faculty of Medicine and Health Sciences, Taiz University, Taiz P.O. Box 6803, Yemen
- Correspondence:
| | - Abdulrahman Hummadi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Badedi
- Administration of Research & Studies, Jazan Health Affairs, Jazan 82611, Saudi Arabia
| | - Hussain Darraj
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Abdullah Khawaji
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Turki Alzughbi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Raed Abutaleb
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ali Jaber Alhagawy
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Awaji Alnami
- Administration of Research & Studies, Jazan Health Affairs, Jazan 82611, Saudi Arabia
| | - Bayan Kudam
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Fatma Bahsan
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Maryam Kariri
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Morghama Adawi
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Daghriri
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Rania Hassan
- Jazan Endocrinology & Diabetes Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Soeid
- Administration of Research & Studies, Jazan Health Affairs, Jazan 82611, Saudi Arabia
| | - Nouf Alzughbi
- Family Medicine Department, Ministry of Health, Jazan 45142, Saudi Arabia
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12
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Corathers S, Williford DN, Kichler J, Smith L, Ospelt E, Rompicherla S, Roberts A, Prahalad P, Basina M, Muñoz C, Ebekozien O. Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network. Curr Diab Rep 2023; 23:19-28. [PMID: 36538250 PMCID: PMC9763798 DOI: 10.1007/s11892-022-01497-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.
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Affiliation(s)
- Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Desireé N Williford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Laura Smith
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Priya Prahalad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marina Basina
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cynthia Muñoz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA
- University of Mississippi School of Population Health, Jackson, MS, USA
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13
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Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems. J Clin Psychol Med Settings 2021; 27:727-745. [PMID: 31587133 DOI: 10.1007/s10880-019-09665-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ2 = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.
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14
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Wisting L, Siegwarth C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. The impact of psychological aspects, age, and BMI on eating disorder psychopathology among adult males and females with type 1 diabetes. Health Psychol Open 2020; 7:2055102920975969. [PMID: 33282331 PMCID: PMC7691919 DOI: 10.1177/2055102920975969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study investigated correlates of eating disorder (ED) psychopathology among
adults with type 1 diabetes (T1D). A total of 282 males (n =
112) and females (n = 170) with T1D (18–79 years) participated.
Overall, psychological aspects (i.e. illness perceptions, coping strategies,
insulin beliefs, anxiety, and depression) were associated with ED
psychopathology. Associations were generally stronger among females than males.
In a regression model, age, BMI, personal control, and anxiety explained 51% of
the variance in ED psychopathology among females, whereas BMI, personal control,
and anxiety explained 47% of the variance among males. Greater clinical
awareness of health psychological aspects may contribute to reduce the risk of
developing ED.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Cecilie Siegwarth
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, University of Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, University of Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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15
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Abstract
PURPOSE OF REVIEW Eating disorders represent one of the most common psychiatric disorders in adolescents with type 1 diabetes mellitus (T1DM), with a prevalence twice as high as in individuals without diabetes. The increased risk for acute and long-term medical complications and a three-fold mortality rate with this dual condition makes it extremely important to screen adolescents for eating disorders as soon as possible. RECENT FINDINGS A number of 13 surveys in the last two years focussed on prevalence rates of disordered eating and associations with sociodemographic, eating disorder-specific and diabetes-related factors in this population. Variations in study design, sample size, age range, sex, instruments to assess eating disorders and outcome make comparisons difficult. Healthcare professionals report challenges in detecting and treating adolescents with this dual condition because of a lack of validated screening tools, guidelines, and integration across specialist care. Studies on psychological treatments for the comorbidity of eating disorders and T1DM are scarce, especially for adolescents. SUMMARY The development and evaluation of psychological treatments for adolescents with eating disorders and T1DM are urgently needed.
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16
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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17
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Troncone A, Cascella C, Chianese A, Zanfardino A, Piscopo A, Borriello A, Casaburo F, Del Giudice EM, Iafusco D. Body Image Problems and Disordered Eating Behaviors in Italian Adolescents With and Without Type 1 Diabetes: An Examination With a Gender-Specific Body Image Measure. Front Psychol 2020; 11:556520. [PMID: 33071880 PMCID: PMC7538612 DOI: 10.3389/fpsyg.2020.556520] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023] Open
Abstract
Objective To examine body image problems and their associations with disordered eating behavior in adolescents with type 1 diabetes and well-matched healthy peers. Methods Using a cross-sectional design, 183 adolescents with type 1 diabetes (13.02–18.05 years) were recruited from diabetes centers in southern Italy and compared to healthy peers matched for age and gender. Participants completed self-report measures of disordered eating behaviors (DEPS-r and EDI-3RF) and a gender-specific body image problem questionnaire (SATAQ-4R). Socio-demographic and clinical data (zBMI, HbA1c, and disease duration) were also collected. Hierarchical multiple linear regression analyses were computed to determine the relative importance of diabetes variables and body image problems on participants’ disordered eating behaviors after controlling for demographic variables. Results Adolescents with type 1 diabetes showed diabetes-specific eating problems in 37.7% of cases and had more eating problem symptoms (assessed as drive for thinness and bulimia) than healthy peers. Male adolescents with type 1 diabetes did not display more body image problems (p > 0.05); females with type 1 diabetes compared to females in the control group were found to be more pressured by family (p = 0.025) but less by media (p = 0.022) to improve their appearance and attain a thin body. zBMI and body image problems contributed to a significant increase in disordered eating behavior risk both in male and female adolescents with diabetes and in healthy peers (zBMI 0.213 < β < 0.426, p < 0.05; body image 0.243 < β < 0.572, p < 0.05). None of the variables analyzed were found to significantly predict male bulimic symptoms (all β < 0.296, p > 0.05). Conclusion Since in adolescence type 1 diabetes and insulin therapy may increase the risk of weight gain and promote focus and attention on the body and thus contribute to the development of body image problems and disordered eating behaviors, continuity of medical, nutritional, and psychological care is needed.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Angela Zanfardino
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alessia Piscopo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Anna Borriello
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Francesca Casaburo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
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18
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Saßmann H, Dehn-Hindenberg A, Jördening M, Huhn F, Landgraf R, Lange K. Gestörtes Essverhalten und psychosoziale Versorgungssituation
junger Menschen mit Typ 1 Diabetes. Psychother Psychosom Med Psychol 2020; 70:449-456. [DOI: 10.1055/a-1142-6705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Zusammenfassung
Einleitung Gestörtes Essverhalten oder klinisch relevante
Essstörungen in Verbindung mit Typ 1 Diabetes haben schwerwiegende
Folgen für die Qualität der Stoffwechseleinstellung und die
langfristige gesundheitliche Prognose Betroffener. Eine frühzeitige
Diagnose und qualifizierte therapeutische Interventionen können bereits
bei gestörtem Essverhalten dazu beitragen, vorzeitige
mikrovaskuläre Schädigungen zu vermeiden. In dieser Studie
wurden für eine Gruppe junger Menschen mit Typ 1 Diabetes, die an einem
4-tägigen Camp teilnahmen, die Prävalenz essgestörten
Verhaltens und die spezifische psychosoziale Versorgungssituation
untersucht.
Material und Methoden Während eines bundesweit ausgeschriebenen
Diabetescamps für junge Menschen (16–29 Jahre) beantworteten die
Teilnehmenden Fragen zu ihrer aktuellen Diabetesbehandlung, zu
diabetesspezifischen Belastungen (PAID-5) sowie zur psychosozialen Versorgung im
Rahmen der ambulanten Langzeittherapie. Symptome gestörten Essverhaltens
wurden mit einem diabetesspezifischen Screeningfragebogen, dem Diabetes Eating
Problem Survey-Revised (DEPS-R), erhoben. Eine lineare multiple Regression wurde
berechnet, um Prädiktoren gestörten Essverhaltens zu
identifizieren.
Ergebnisse An der Umfrage beteiligten sich 308 junge Menschen mit Typ 1
Diabetes (Alter 21,4±3,4 Jahre; 73% weiblich; Diabetesdauer
10,2±5,9 Jahre; 74% in internistischer Behandlung). Bei
28,2% der Befragten ergaben sich Hinweise auf ein gestörtes
Essverhalten (17% der Männer, 32% der Frauen).
Teilnehmende mit einem auffälligen Summenwert im DEPS-R wurden nur zu
7% entsprechend psychologisch betreut. Das HbA1c, der BMI, die
diabetesspezifischen Belastungen, das Alter, die Diabetesdauer sowie das
Geschlecht erwiesen sich als signifikante Prädiktoren für das
Ausmaß gestörten Essverhaltens.
Diskussion Unter den Teilnehmenden eines Diabetescamps für junge
Menschen zeigten sich bei über einem Viertel Hinweise auf ein
gestörtes Essverhalten. Insgesamt waren davon junge Frauen
häufiger betroffen, weitere relevante Risikofaktoren waren ein
erhöhter BMI, ein höheres HbA1c und stärkere
diabetesspezifische Belastungen. Nur ein sehr geringer Anteil der jungen
Menschen mit Typ 1 Diabetes und gestörtem Essverhalten erhielt
psychologische Unterstützung.
Schlussfolgerung In der ambulanten diabetologischen Versorgung sollten
diabetesspezifische Screeninginstrumente und/oder gezielte
Screeningfragen insbesondere bei jungen Frauen regelmäßig
eingesetzt und die Ergebnisse mit den Betroffenen im Hinblick auf eine
weiterführende Behandlung besprochen werden.
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Affiliation(s)
- Heike Saßmann
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | | | - Mia Jördening
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Friederike Huhn
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Rüdiger Landgraf
- Bevollmächtigter des Vorstands, Deutsche Diabetes Stiftung,
München
| | - Karin Lange
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
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19
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Pursey KM, Hart M, Jenkins L, McEvoy M, Smart CE. Screening and identification of disordered eating in people with type 1 diabetes: A systematic review. J Diabetes Complications 2020; 34:107522. [PMID: 31928891 DOI: 10.1016/j.jdiacomp.2020.107522] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 12/18/2022]
Abstract
People with Type 1 diabetes (T1D) have been shown to be an at-risk group for the development of disordered eating behaviours, however, the validity of tools used to assess disordered eating behaviours in T1D is unclear. This review aimed to identify tools used to screen or identify disordered eating behaviours and eating disorders in people with T1D, and evaluate the validity and reliability of these tools. A systematic search strategy was conducted to October 2019 according to the PRISMA guidelines. The search strategy retrieved 2714 articles, with 100 articles describing 90 studies included in the review. Studies were predominantly conducted in adolescent females in clinical settings. Forty-eight individual tools were used across retrieved studies. Overall, the quality of tools reported in included articles was poor, with high risk of bias due to the use of non-validated tools (n = 44 articles) and few studies comparing to the reference standard (n = 10 articles) of a diagnostic interview. This review shows that a variety of tools have been used to screen and identify disordered eating behaviours and eating disorders in people with T1D. Future research including comparison to a gold standard diagnostic interview is warranted to further evaluate the validity and reliability of available tools.
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Affiliation(s)
- Kirrilly M Pursey
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter New England Mental Health, Waratah, New South Wales 2298, Australia.
| | - Melissa Hart
- Hunter New England Mental Health, Waratah, New South Wales 2298, Australia; School of Health Sciences, University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Laura Jenkins
- Hunter New England Mental Health, Waratah, New South Wales 2298, Australia
| | - Mark McEvoy
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales 2308, Australia; Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, New South Wales 2303, Australia
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20
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Broadley MM, Zaremba N, Andrew B, Ismail K, Treasure J, White MJ, Stadler M. 25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt? Diabet Med 2020; 37:401-408. [PMID: 31797439 DOI: 10.1111/dme.14197] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Disordered eating is a serious and under-recognized problem in people with diabetes. This narrative review summarizes the research contributions made by psychological science over the past 25 years to the study of disordered eating in people with type 1 or type 2 diabetes, and identifies gaps and future directions relevant to both healthcare professionals and researchers. Key focus areas of psychological research investigating disordered eating in people with diabetes have been: (1) defining and classifying types of disordered eating; (2) identifying demographic, diabetes-specific and psychosocial correlates of disordered eating, and developing theoretical models of disordered eating in people with type 1 diabetes; (3) identifying the physical and psychosocial consequences of disordered eating; and (4) developing screening measures to identify disordered eating in people with type 1 diabetes. Psychological science has made significant contributions over the past 25 years to our understanding of the nature of this problem and the multiple factors which may interrelate with disordered eating in people with diabetes. Key areas for further attention include: (1) a better definition of disordered eating subtypes in people with type 1 diabetes; (2) characterizing disordered eating in people with type 2 diabetes; and (3) developing multidisciplinary, evidence-based prevention and treatment interventions for comorbid disordered eating and diabetes.
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MESH Headings
- Behavioral Research/history
- Behavioral Research/methods
- Behavioral Research/trends
- Biomedical Research/history
- Biomedical Research/methods
- Biomedical Research/trends
- Diabetes Complications/epidemiology
- Diabetes Complications/etiology
- Diabetes Complications/psychology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/psychology
- Feeding and Eating Disorders/complications
- Feeding and Eating Disorders/epidemiology
- Feeding and Eating Disorders/psychology
- History, 20th Century
- History, 21st Century
- Humans
- Psychology/history
- Psychology/methods
- Psychology/trends
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Affiliation(s)
- M M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - N Zaremba
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | - B Andrew
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - K Ismail
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, London, UK
| | - J Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M J White
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - M Stadler
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
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Smith LB, Foster N, Bollepalli S, Fitterman-Harris HF, Rancourt D. An Examination of Sex Differences in a Disease-Specific Model of Disordered Eating Behaviors in Type 1 Diabetes. J Pediatr Psychol 2020; 45:91-100. [PMID: 31764987 PMCID: PMC6964220 DOI: 10.1093/jpepsy/jsz090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Preliminary evidence supports the integration of type 1 diabetes (T1D) disease-specific factors into eating disorder risk models. The current study explored whether cross-sectional associations among constructs included in the modified dual pathway model of eating disorder risk for individuals with T1D are similar across sex among adolescents and young adults with T1D. METHODS Original study participants were recruited from the T1D Exchange Clinic Network, a U.S. registry of individuals with T1D. Online surveys included measures of general eating disorder risk factors, hypothesized T1D-specific risk factors, and a T1D-specific eating disorder questionnaire. The current study is a secondary analysis with the adolescents (13-17 years; n = 307; 46.9% female) and young adults (18-25 years; n = 313; 62.6% female) from the original sample. In the absence of strong measurement invariance for all measures of interest, sex-specific path models were estimated among the adolescent and young adult cohorts. RESULTS Only two paths emerged as significant in the female, but not male, adolescent model. In the young adult cohort, all significant paths were the same across sex. CONCLUSIONS Both general and T1D-specific risk factors are associated with disordered eating behaviors in the T1D population. Patterns of associations were similar across male and female youth with T1D, suggesting that sex-specific prevention approaches to disordered eating behaviors among T1D youth may not be warranted.
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Affiliation(s)
- Laura B Smith
- Department of Pediatrics, Diabetes & Endocrinology Center, Morsani College of Medicine, University of South Florida
| | | | - Sureka Bollepalli
- Department of Pediatrics, Diabetes & Endocrinology Center, Morsani College of Medicine, University of South Florida
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