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Dean YE, Motawea KR, Aslam M, Pintado JJL, Popoola‐Samuel HAO, Salam M, Dundi POR, Donaldy W, Aledani EM, Alqiqie Z, Sultana N, Mohamed ARH, Elalem A, Syeda STH, Mohamed MS, Assal MW, Attia NM, Hagar H, Abdelaziz HA, Subedi A, Elbahaie A, Hazimeh Y, Aiash H. Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis. Endocrinol Diabetes Metab 2024; 7:e473. [PMID: 38597269 PMCID: PMC11005101 DOI: 10.1002/edm2.473] [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: 11/13/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Previous meta-analyses have shown mixed results regarding the association between eating disorders (EDs) and type 1 diabetes mellitus (T1DM). Our paper aimed to analyse different EDs and disordered eating behaviours that may be practiced by patients with T1DM. METHODS A literature search of PubMed, Scopus and Web of Science was conducted on 17 January 2023, using the key terms "T1DM," "Eating Disorders" and "Bulimia." Only observational controlled studies were included. The Revman software (version 5.4) was used for the analysis. RESULTS T1DM was associated with increased risk of ED compared with nondiabetic individuals (RR = 2.47, 95% CI = 1.84-3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18-6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18-1.98, p-value = 0.001). Our analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91-4.12, p-value < 0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27-3.23, p-value = 0.003). Prevalence of insulin omission/misuse was 10.3%; diabetic females demonstrated a significantly higher risk of insulin omission and insulin misuse than diabetic males. CONCLUSION Our study establishes a significant and clear connection between EDs and T1DM, particularly bulimia and binge eating, with T1DM. Moreover, female diabetics are at higher risk of insulin misuse/omission. Early proactive screening is essential and tailored; comprehensive interventions combining diabetes and ED components are recommended for this population, with referral to a specialised psychiatrist.
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Affiliation(s)
- Yomna E. Dean
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | - Muaaz Aslam
- Shaikh Khalifa Bin Zayed Al‐Nahyan Medical and Dental CollegeLahorePakistan
| | | | | | | | | | | | | | | | | | | | - Amir Elalem
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | | | | | | | - Hanan Hagar
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | | | - Anuj Subedi
- Prithvi Narayan Community HospitalGorkhaNepal
| | | | | | - Hani Aiash
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
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Wisting L, Haugvik S, Wennersberg AL, Hage TW, Stice E, Olmsted MP, Ghaderi A, Brunborg C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. A pilot study of a virtually delivered dissonance-based eating disorder prevention program for young women with type 1 diabetes: within-subject changes over 6-month follow-up. Eat Disord 2024:1-17. [PMID: 38511886 DOI: 10.1080/10640266.2024.2331391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
INTRODUCTION In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. METHODS Young women with T1D aged 16-35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. RESULTS Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen's ds ranged from .34 to 1.70). CONCLUSION The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
| | - Severina Haugvik
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetes Centre, Oslo, Norway
| | - Anne Louise Wennersberg
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Wiig Hage
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Eric Stice
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, USA
| | - Marion P Olmsted
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Cathrine Brunborg
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetes Centre, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetes Centre, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Oslo, Norway
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3
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Perrin EC, Ravi HL, Borra GS, South AM. Prevalence and risk factors of disordered eating behavior in youth with hypertension disorders. Pediatr Nephrol 2023; 38:3779-3789. [PMID: 37195544 PMCID: PMC10189692 DOI: 10.1007/s00467-023-05921-1] [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: 11/21/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Adolescents with certain health conditions requiring lifestyle management, such as diabetes mellitus, have higher disordered eating behavior (DEB) risk than the general adolescent population, but DEB is underdiagnosed and can lead to adverse health consequences. In youth with other conditions requiring lifestyle counseling such as hypertension (HTN), DEB prevalence and associated risk factors are unknown. We hypothesized that youth with HTN disorders would have higher DEB prevalence than the general adolescent population, and that obesity, chronic kidney disease (CKD), and less specialized lifestyle counseling would be associated with higher DEB risk. METHODS Prospective cross-sectional study of youth aged 11-18 years with HTN disorders. We excluded patients with diabetes mellitus, kidney failure or transplantation, or gastrostomy tube dependence. We collected data via surveys and electronic health record abstraction. We administered the validated SCOFF DEB screening questionnaire. We compared DEB prevalence using a one-sample z-test of proportions (p0 = 0.1) and estimated DEB risk by obesity, CKD, and lifestyle counseling source using multivariable generalized linear models. RESULTS Of 74 participants, 59% identified as male, 22% as Black or African American, and 36% as Hispanic or Latino; 58% had obesity and 26% had CKD. DEB prevalence was 28% (95% CI 18-39%, p < 0.001). CKD was associated with higher DEB prevalence (adjusted RR 2.17, 95% CL 1.09 to 4.32), but obesity and lifestyle counseling source were not. CONCLUSIONS DEB prevalence is higher in youth with HTN disorders and comparable to other conditions requiring lifestyle counseling. Youth with HTN disorders may benefit from DEB screening. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ella C Perrin
- Department of Pediatrics, Section of Nephrology, Brenner Children's, Wake Forest University School of Medicine, One Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Hanna L Ravi
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gagana S Borra
- Department of Pediatrics, Section of Nephrology, Brenner Children's, Wake Forest University School of Medicine, One Medical Center Boulevard, Winston Salem, NC, 27157, USA
| | - Andrew M South
- Department of Pediatrics, Section of Nephrology, Brenner Children's, Wake Forest University School of Medicine, One Medical Center Boulevard, Winston Salem, NC, 27157, USA.
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA.
- Cardiovascular Sciences Center, Wake Forest University School of Medicine, Winston Salem, NC, USA.
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston Salem, NC, USA.
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4
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Dziewa M, Bańka B, Herbet M, Piątkowska-Chmiel I. Eating Disorders and Diabetes: Facing the Dual Challenge. Nutrients 2023; 15:3955. [PMID: 37764739 PMCID: PMC10538145 DOI: 10.3390/nu15183955] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Eating disorders and diabetes mellitus are distinct yet closely linked health conditions, presenting distinct challenges in terms of care and management. Eating disorders encompass a spectrum of mental health disorders characterized by abnormal eating behaviors and disruptions in weight regulation. Research indicates that individuals with diabetes might be at an elevated risk of developing eating disorders. The necessity to adhere to specific dietary guidelines, monitor blood sugar levels vigilantly, and manage drug administration can collectively contribute to the emergence of detrimental attitudes toward food and body image. On the other hand, incorrect eating behaviors such as binge eating and purging can disrupt blood sugar control, significantly impacting the development and management of diabetes. This intricate relationship emphasizes the crucial necessity for a comprehensive understanding and specialized care to effectively address the dual challenges faced by individuals dealing with both diabetes and eating disorders. This paper represents the inaugural comprehensive review delving into the intricate connection between eating disorders and diabetes, thereby illuminating previously under-researched areas. The insights gleaned from this review may contribute to developing integrated interventions that aim to improve the overall well-being and quality of life for individuals grappling with the complexities of eating disorders and diabetes.
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Affiliation(s)
| | | | | | - Iwona Piątkowska-Chmiel
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8b Street, 20-090 Lublin, Poland
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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: 0] [Impact Index Per Article: 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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6
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Abild CB, Jensen AL, Lassen RB, Vestergaard ET, Bruun JM, Kristensen K, Støving RK, Clausen L. Patients' perspectives on screening for disordered eating among adolescents with type 1 diabetes. Eat Weight Disord 2023; 28:4. [PMID: 36754894 PMCID: PMC9908670 DOI: 10.1007/s40519-023-01539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/29/2022] [Indexed: 02/10/2023] Open
Abstract
PURPOSE People with type 1 diabetes have an increased risk of disordered eating (DE) and eating disorders (ED). Screening is recommended however little is known about patients' perspectives on screening questionnaires. This paper reports qualitative analyses of patients' perspectives on the questionnaire Diabetes Eating Problem Survey Revised (DEPS-R), including acceptability, attitudes, and cognitive understanding. RESEARCH DESIGN AND METHODS 15 adolescents with type 1 diabetes between 11 and 18 years, were interviewed. A semi-structured format and a qualitative Interpretive Descriptive (ID) methodology was chosen. RESULTS The analyses identified four themes: (1) The Questionnaire, (2) Reframing Diabetes Visits, (3) This is (not) for me, and (4) Out in the Open. The DEPS-R was completed with-in 5-10 min. with no technical difficulties. The questionnaire altered the diabetes visit for some, creating a new dialog, and time for self-reflection. Adolescents appreciated the direct approach in the questionnaire, and showed willingness to complete the questionnaire, when presented to them by a health care professional (HCP). One item in the DEPS-R proved difficult to understand for some participants. CONCLUSION The study highlights DEPS-R as a clinically relevant screening questionnaire. Completing DEPS-R prior to a consultation opens the door to a consultation that invites the adolescent to address matters of eating behavior. Our findings suggest that systematic screening of DE/ED using the DEPS-R is both accepted and welcomed by adolescents with type 1 diabetes. Future research should focus on a potential update of selected items in DEPS-R. LEVEL OF EVIDENCE V - qualitative study.
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Affiliation(s)
- Caroline Bruun Abild
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Danish National Center for Obesity, Copenhagen, Denmark.
| | - Annesofie Lunde Jensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Pediatric Clinic, Regional Hospital Randers, Randers, Denmark
| | - Jens Meldgaard Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish National Center for Obesity, Copenhagen, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Esbjerg, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry-Research unit, Aarhus University Hospital, Aarhus, Denmark
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Trott M, Driscoll R, Pardhan S. Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses. BMC Endocr Disord 2022; 22:311. [PMID: 36494641 PMCID: PMC9733253 DOI: 10.1186/s12902-022-01236-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is a complication of diabetes affecting the eyes and can lead to blindless if left untreated. Several significant risk factors have been reported for DR, of which several can be classified as some form of disease. Furthermore, several systematic reviews have reported associations between several types of mortality and DR. Numerous meta-analyses have pooled the data on these factors, however, a systematic evaluation of these meta-analytic relationships is lacking. In this study, therefore, we performed an umbrella review of systematic reviews of meta-analyses for mortality, diseases and DR, grading the credibility of evidence. METHODS A comprehensive database search for observational meta-analyses was conducted from inception until 29/04/2022 against pre-published inclusion criteria. For each meta-analytic outcome, a random-effects meta-analysis was re-conducted, stratifying by study design (and type of DR where possible) of included studies. Several statistical variables, including publication bias, heterogeneity, excess significance bias, and prediction intervals were used to grade the credibility of significant evidence from I to IV, using the recommendations from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Of the 1,834 initial results, 11 systematic reviews with meta-analyses were included covering 16 independent outcomes (total participants = 299,655; median participants per outcome: 7,266; median individual studies per outcome = 5). Overall, 10/16 outcomes (62.5%) yielded significant results, most of which were graded as 'highly suggestive' (Grade II) evidence. DR was associated with all-cause and cardio-vascular mortality, obstructive sleep apnoea, depression eating disorders, and several forms of cognitive impairment. CONCLUSIONS Results show highly suggestive evidence for associations between health outcomes and/or conditions and DR. Public health professionals and practitioners should note these findings when developing and/or reviewing public health polices.
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Affiliation(s)
- Mike Trott
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK.
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Robin Driscoll
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK
| | - Shahina Pardhan
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK
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de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, Delamater AM, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes 2022; 23:1373-1389. [PMID: 36464988 PMCID: PMC10107478 DOI: 10.1111/pedi.13428] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, Netherlands
| | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda A DiMeglio
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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9
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Brown SC, Whelan K, Frampton C, Wall CL, Gearry RB, Day AS. Food-Related Quality of Life in Children and Adolescents With Crohn's Disease. Inflamm Bowel Dis 2022; 28:1838-1843. [PMID: 35166341 DOI: 10.1093/ibd/izac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food-related quality of life (FRQoL) encompasses the psychosocial elements of eating and drinking. The FRQoL of children and adolescents with inflammatory bowel disease has not yet been assessed. This study aimed to evaluate the utility of the validated FR-Qol-29 instrument in children with Crohn's disease (CD). METHODS Children diagnosed with CD, a shared home environment healthy sibling, and healthy control subjects 6 to 17 years of age were recruited to this single-center, prospective, cross-sectional study. Children or their parent or guardian completed the FR-QoL-29 instrument. Internal consistency was assessed by completing Cronbach's α. Construct validity was established by correlating the CD FR-QoL-29 sum scores with the Physician Global Assessment and Pediatric Crohn Disease Activity Index scores. The discriminant validity was analyzed using a 1-way analysis of variance, and a Spearman's correlation coefficient test was completed to identify any correlations associated with FRQoL. RESULTS Sixty children or their parent or guardian completed the FR-QoL-29 instrument (10 children in each subgroup). The internal consistency was excellent (Cronbach's α = 0.938). The mean FR-QoL-29 sum scores were 94.3 ± 27.6 for CD, 107.6 ± 20 for siblings, and 113.7 ± 13.8 for control subjects (P = .005). Those with higher disease activity had worse FRQoL (Physician Global Assessment P = .021 and Pediatric Crohn Disease Activity Index P = .004). Inflammatory bowel disease FR-QoL-29 sum scores correlated with weight (P = .027), height (P = .035), body mass index (P = .023), and age (P = .015). CONCLUSIONS FRQoL is impaired in children with CD. Healthy siblings also have poorer FRQoL than control subjects. Several clinical factors are associated with poorer FRQoL in children with CD including age and level of nutritional risk (weight, height, and body mass index). Further research is required validate these findings and to develop strategies for the prevention or treatment of impaired FRQoL in children with CD.
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Affiliation(s)
- Stephanie C Brown
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Chris Frampton
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Catherine L Wall
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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10
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Trott M, Driscoll R, Iraldo E, Pardhan S. Pathological eating behaviours and risk of retinopathy in diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord 2022; 21:1047-1054. [PMID: 35673454 PMCID: PMC9167365 DOI: 10.1007/s40200-022-00980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/13/2022] [Indexed: 01/23/2023]
Abstract
Background Diabetes mellitus can cause several long-term macrovascular and microvascular complications including nephropathy, neuropathy, and retinopathy (DR). Several studies have reported positive associations between eating pathologies and DR; however, these studies have not been aggregated and sub-grouped into type of pathological eating behaviour, and the differences in risk according to type of eating behaviour is unknown. The aim of this review, therefore, was to aggregate risks of DR in populations with and without pathological eating behaviours, stratified according to eating behaviour. Methods A systematic review and meta-analysis was conducted. Major databases and grey literature were search from inception until 1/6/2021. Studies reporting the prevalence of pathological eating behaviours (against a control group with no pathological eating behaviours) in diabetic people with and without DR were included. Odds ratios were calculated from primary data. Results Seven studies with eight independent outcomes with a total of 1162 participants were included. The odds ratio of DR in the total pooled analysis was 2.94 (95%CI 1.86-4.64; p = <0.001; I2 = 29.59). Two types of eating behaviour yielded enough data for sub-group analysis. Eating disorder not otherwise specified yielded an odds ratio of 2.73 (95%CI 1.81-4.10; p = <0.001; I2 = 0.00), and binge eating disorder yielded an non-significant odds ratio of 0.92 (95%CI 0.31-2.77; p = 0.887;I2 = 0.00). Discussion The likelihood of DR increases almost three times in the presence of pathological eating behaviours. More studies are required to confirm this in clinical populations stratified by eating disorder. Practitioners working with people with diabetes should closely monitor eating behaviours to preclude this risk. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-00980-x.
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Affiliation(s)
- Mike Trott
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
| | - R. Driscoll
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
| | - E. Iraldo
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
| | - S. Pardhan
- Vision and Eye Research institute (VERI), Anglia Ruskin University Young Street, Cambridge, CB1 2LZ UK
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11
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Determining the risk of diabulimia and its relationship with diet quality and nutritional status of adolescents with type 1 diabetes. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Liu S, Kuja-Halkola R, Larsson H, Lichtenstein P, Ludvigsson JF, Svensson AM, Gudbjörnsdottir S, Tideman M, Serlachius E, Butwicka A. Neurodevelopmental Disorders, Glycemic Control, and Diabetic Complications in Type 1 Diabetes: a Nationwide Cohort Study. J Clin Endocrinol Metab 2021; 106:e4459-e4470. [PMID: 34171098 PMCID: PMC8530713 DOI: 10.1210/clinem/dgab467] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Indexed: 01/16/2023]
Abstract
CONTEXT Neurodevelopmental disorders are more prevalent in childhood-onset type 1 diabetes than in the general population, and the symptoms may limit the individual's ability for diabetes management. OBJECTIVE This study investigated whether comorbid neurodevelopmental disorders are associated with long-term glycemic control and risk of diabetic complications. METHODS This population-based cohort study used longitudinally collected data from Swedish registers. We identified 11 326 individuals born during 1973-2013, diagnosed with type 1 diabetes during 1990-2013 (median onset age: 9.6 years). Among them, 764 had a comorbid neurodevelopmental disorder, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability. We used multinomial logistic regression to calculate odds ratios (ORs) of having poor glycemic control (assessed by glycated hemoglobin [HbA1c]) and Cox regression to estimate hazard ratios (HRs) of nephropathy and retinopathy. RESULTS The median follow-up was 7.5 years (interquartile range [IQR] 3.9, 11.2). Having any neurodevelopmental disorder (ORadjusted 1.51 [95% CI 1.13, 2.03]), or ADHD (ORadjusted 2.31 [95% CI 1.54, 3.45]) was associated with poor glycemic control (mean HbA1c > 8.5%). Increased risk of diabetic complications was observed in patients with comorbid neurodevelopmental disorders (HRadjusted 1.72 [95% CI 1.21, 2.44] for nephropathy, HRadjusted 1.18 [95% CI 1.00, 1.40] for retinopathy) and patients with ADHD (HRadjusted 1.90 [95% CI 1.20, 3.00] for nephropathy, HRadjusted 1.33 [95% CI 1.07, 1.66] for retinopathy). Patients with intellectual disability have a particularly higher risk of nephropathy (HRadjusted 2.64 [95% CI 1.30, 5.37]). CONCLUSION Comorbid neurodevelopmental disorders, primarily ADHD and intellectual disability, were associated with poor glycemic control and a higher risk of diabetic complications in childhood-onset type 1 diabetes.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- School of Medical Sciences, Örebro University, 70182 Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- Department of Pediatrics, Örebro University Hospital, 70185 Örebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Centre of Registers, 413 45 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, 413 45 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Magnus Tideman
- School of Health and Social Science, Halmstad University, 301 18 Halmstad, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Service, Region Stockholm, 171 77 Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Service, Region Stockholm, 104 31 Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
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13
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Hall R, Keeble L, Sünram-Lea SI, To M. A review of risk factors associated with insulin omission for weight loss in type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:606-616. [PMID: 34121470 PMCID: PMC8264633 DOI: 10.1177/13591045211026142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.
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Affiliation(s)
- Rebecca Hall
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | - Leanna Keeble
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | | | - Michelle To
- Department of Psychology, 4396Lancaster University, Lancaster, UK
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14
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Tan J, Johns G. The Welsh Eating Disorder Service Review 2018, Scottish Eating Disorder Service Review 2021 and recommendations of best practice in comorbid eating disorders and diabetes. Clin Child Psychol Psychiatry 2021; 26:595-605. [PMID: 34116593 DOI: 10.1177/13591045211013855] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes and eating disorders are frequently comorbid. This particular comorbidity is not only often poorly recognised, but is difficult to treat and has a high mortality. METHOD In this article, we will briefly review the relationship between diabetes and eating disorders. We will review the current NICE and other guidance and reports concerning both diabetes and eating disorders in the United Kingdom. We will then describe the recommendations of the 2018 Welsh Government Eating Disorder Service Review and the 2021 the Scottish Government Eating Disorder Service Review regarding diabetes and eating disorders, which will lead to service change. CONCLUSIONS We conclude that this is a relatively underdeveloped but important area where there needs to be further service development and more collaboration between diabetes and eating disorder services.
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Affiliation(s)
- Jacinta Tan
- Aneurin Bevan University Health Board, Ty Bryn Unit, St Cadocs Hospital, Newport, UK
| | - Gemma Johns
- Aneurin Bevan University Health Board, Newport, UK
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15
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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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16
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Tate AE, Liu S, Zhang R, Yilmaz Z, Larsen JT, Petersen LV, Bulik CM, Svensson AM, Gudbjörnsdottir S, Larsson H, Butwicka A, Kuja-Halkola R. Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden. Diabetes Care 2021; 44:1143-1150. [PMID: 33824142 PMCID: PMC8132321 DOI: 10.2337/dc20-2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To ascertain the association and coaggregation of eating disorders and childhood-onset type 1 diabetes in families. RESEARCH DESIGN AND METHODS Using population samples from national registers in Sweden (n = 2,517,277) and Demark (n = 1,825,920), we investigated the within-individual association between type 1 diabetes and eating disorders and their familial coaggregation among full siblings, half siblings, full cousins, and half cousins. On the basis of clinical diagnoses, we classified eating disorders into any eating disorder (AED), anorexia nervosa (AN) and atypical AN, and other eating disorder (OED). Associations were determined with hazard ratios (HRs) with 95% CIs from Cox regressions. RESULTS Swedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an eating disorder diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80-2.27], AN 1.63 [1.36-1.96], OED 2.34 [2.07-2.63]; Denmark: AED 2.19 [1.84-2.61], AN 1.78 [1.36-2.33], OED 2.65 [2.20-3.21]). We also meta-analyzed the results: AED 2.07 (1.88-2.28), AN 1.68 (1.44-1.95), OED 2.44 (2.17-2.72). There was an increased risk of receiving an eating disorder diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07-1.46], AN 1.28 [1.04-1.57], OED 1.28 [1.07-1.52]); these results were nonsignificant in the Danish cohort. CONCLUSIONS Patients with type 1 diabetes are at a higher risk of subsequent eating disorders; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and an eating disorder diagnosis. Diabetes health care teams should be vigilant about disordered eating behaviors in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Ashley E Tate
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ruyue Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janne T Larsen
- National Centre for Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Liselotte V Petersen
- National Centre for Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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17
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Instrument Context Relevance Evaluation, Translation, and Psychometric Testing of the Diabetes Eating Problem Survey-Revised (DEPS-R) among People with Type 1 Diabetes in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073450. [PMID: 33810376 PMCID: PMC8037186 DOI: 10.3390/ijerph18073450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
Background: People with type 1 diabetes are susceptible to disordered eating behaviors. The American Diabetes Association recommends using the Diabetes Eating Problem Survey-Revised (DEPS-R) to screen them. There is no validated diabetes-specific screening measure in China. The objectives were to adapt DEPS-R into Mandarin Chinese and to test its psychometric properties among youths and adults with type 1 diabetes in China, respectively. Methods: This study was conducted in two phases. Phase 1 included context relevance evaluation and instrument translation. Phase 2 was psychometric testing of reliability and construct validity among 89 youths (8~17 years old) and 61 adults with type 1 diabetes. Result: The Context Relevance Index and Translation Validity Index of this instrument were good. Strong internal consistency reliability correlations and convergent validity were demonstrated among youths and adults. Discussion: The Chinese version of the DEPS-R is a valid and reliable tool for screening disordered eating behaviors in Chinese youths and adults with type 1 diabetes. The Context Relevance Index is advocated to evaluate the difference between the context in which an instrument was originally developed and the target context.
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18
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Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis. Diagnostics (Basel) 2020; 10:diagnostics10121044. [PMID: 33287458 PMCID: PMC7761849 DOI: 10.3390/diagnostics10121044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Disordered eating behaviors (DEBs), including diagnosable eating disorders, are quite common and can interfere with optimal type 1 diabetes (T1DM) management. We explored DEBs prevalence in youth with T1DM, proposing news diagnostic subscales, to represent the clinical dimensions associated with feeding and eating disorders (ED); Methods: additionally to SCOFF questionnaire and Diabetes Eating Problem Survey–Revised (DEPS-R), four subscales combined from the original DEPS-R questionnaire were administered to 40 youths with T1DM (15.0 ± 2.6); Results: females showed higher scores than males in DEPS-R original factor 2 (“preoccupations with thinness/weight”, p = 0.024) and in DEPS-R proposed “restriction” factor (p = 0.009). SCOFF scores was correlated with original DEPS-R factors 1 (“maladaptive eating habits”) and 2 (p < 0.001) and with the newly proposed DEPS-R factors: restriction, disinhibition, compensatory behaviors, diabetes management (all p < 0.02). Diabetes management was the only factor related to glycated hemoglobin level (p = 0.006). Patients with high DEPS-R score (≥20) scored higher than patients with low (<20) DEPS-R score in DEPS-R original factors 1 (p < 0.001) and 2 (p = 0.002) as well as in the proposed factors including restriction, disinhibition, diabetes management (all p < 0.02); Conclusions: the complicated nature of DEBs calls for the development target specific questionnaires to be used as screening tools to detect cases of DEBs and exclude non cases. Early recognition of DEBs in adolescents with T1DM is essential for effective prevention and successful treatment.
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19
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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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20
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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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21
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Coleman SE, Caswell N. Diabetes and eating disorders: an exploration of 'Diabulimia'. BMC Psychol 2020; 8:101. [PMID: 32967730 PMCID: PMC7513317 DOI: 10.1186/s40359-020-00468-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
Background ‘Diabulimia’ is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research. Methods Forty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis. Results The average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction. Conclusions Overall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider.
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Affiliation(s)
| | - Noreen Caswell
- Senior Lecturer, School of Psychology, University of Central Lancashire, Preston, UK
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22
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Nilsson F, Madsen JOB, Jensen AK, Olsen BS, Johannesen J. High prevalence of disordered eating behavior in Danish children and adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:1043-1049. [PMID: 32418266 DOI: 10.1111/pedi.13043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE A higher prevalence of disordered eating behavior (DEB) has been demonstrated in children and adolescents with type 1 diabetes (T1D) compared to healthy aged-matched peers. DEB is associated with higher HbA1c levels and increased risk of developing complications to T1D. The aim of this study was to determine the prevalence of DEB in a Danish cohort of children and adolescents with T1D aged 11 to 19 years and to characterize them regarding metabolic control and relevant clinical data. RESEARCH DESIGN AND METHODS In a cross-sectional study, we determined the prevalence of DEB using the revised Diabetes Eating Problem Survey (DEPS-R) questionnaire. HbA1c and relevant clinical data were obtained at the time they filled in the questionnaire. RESULTS Hundred and ninety-two children and adolescents (46% girls) aged 11 to 19 years with T1D were included from the pediatric diabetes outpatient clinic. A total of 40 participants (21%) had DEB. The prevalence was higher among girls compared with boys (34.1% vs 8.9%) and those who had DEB were older (16.7 vs 15.0 years, P < .001), had longer duration of T1D (7.5 vs 4.9 years, P < .001), higher BMI Z-scores (1.2 vs 0.3, P < .001), higher HbA1c (72.8 (8.8%) vs 62.0 (7.8%) mmol/mol, P < .001), higher total cholesterol (4.6 mmol/L vs 4.2 mmol/L, P = .0048), and LDL (2.7 vs 2.3, P = .001) compared with those with no signs of DEB. CONCLUSION As in other countries, the prevalence of DEB is high in Danish adolescents with T1D. Early detection of DEB is essential to prevent short- and long-term complications to T1D.
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Affiliation(s)
- Franciska Nilsson
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | | | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health , University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Birthe Susanne Olsen
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | - Jesper Johannesen
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Impact of Nutrition Knowledge, Dietary Composition, and Eating Behaviors in Adolescents With Type 1 Diabetes. TOP CLIN NUTR 2020. [DOI: 10.1097/tin.0000000000000203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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24
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Luyckx K, Verschueren M, Palmeroni N, Goethals ER, Weets I, Claes L. Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study. Diabetes Care 2019; 42:1637-1644. [PMID: 31217162 DOI: 10.2337/dc19-0445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Disturbed eating behavior (DEB) is prevalent in youth with type 1 diabetes and is accompanied by an increased risk for complications, morbidity, and mortality. Prospective studies on DEB in the challenging transition to adulthood are scarce. This longitudinal study examined DEB over a 1-year period and investigated the directionality of effects linking DEB to diabetes-specific functioning and depressive symptoms in adolescents and emerging adults. RESEARCH DESIGN AND METHODS Three hundred youth (16-28 years old) with type 1 diabetes participated in a two-wave longitudinal study. Questionnaires measured DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms. HbA1c values were obtained from physicians. Mixed ANOVA and cross-lagged analysis were used to examine prospective changes and directionality of effects, respectively. RESULTS Mean DEB remained stable in the total sample, but significant individual differences were observed based on the cutoff score of the DEPS-R: 19% displayed persistent DEB and 8% increased and 7.3% decreased in DEB over time. The remaining individuals scored low on DEB over time. These four groups were differentiated based on insulin restriction, omission, diabetes-specific functioning, and depressive symptoms. Cross-lagged analyses indicated that DEB predicted relative increases in depressive symptoms over time, whereas reciprocal associations with glycemic control were found. CONCLUSIONS This longitudinal study highlights the substantial impact DEB may have in the transition to adulthood, with a substantial portion of youth with type 1 diabetes being at risk for clinical DEB. Prospective pathways linking DEB to functioning were found, emphasizing the clinical relevance of assessing DEB over time.
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Affiliation(s)
- Koen Luyckx
- University of Leuven, Leuven, Belgium .,Unit for Professional Training and Service in the Behavioral Sciences, University of the Free State, Bloemfontein, South Africa
| | - Margaux Verschueren
- University of Leuven, Leuven, Belgium.,FWO Research Foundation Flanders, Brussels, Belgium
| | | | - Eveline R Goethals
- University of Leuven, Leuven, Belgium.,Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Ilse Weets
- Free University Brussels, Brussels, Belgium
| | - Laurence Claes
- University of Leuven, Leuven, Belgium.,University of Antwerp, Antwerp, Belgium
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Gallagher KAS, DeSalvo D, Gregory J, Hilliard ME. Medical and Psychological Considerations for Carbohydrate-Restricted Diets in Youth With Type 1 Diabetes. Curr Diab Rep 2019; 19:27. [PMID: 31030356 DOI: 10.1007/s11892-019-1153-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Given the challenges achieving recommended glycemic targets in youth with type 1 diabetes (T1D), providers may consider recommending carbohydrate-restricted diets (CRDs) to optimize glycemic control. The goal of the present review is to describe relevant literature on the potential medical and psychosocial benefits and risks of CRDs in youth with T1D. RECENT FINDINGS Limited data exist on the effects of CRDs in pediatric populations. Findings from studies with youth and adults are mixed; some indicate that CRDs may be associated with desirable medical outcomes, such as improved glycemic control and reduced HbA1c, which may contribute to positive psychological outcomes such as reduced diabetes distress and depressive symptoms. Others suggest that CRDs may also be associated with detrimental outcomes, including mineral deficiencies and suboptimal growth, and dietary restriction has been linked to greater diabetes distress, disordered eating, and diabetes management. More research is needed to evaluate benefits and risks of CRDs in youth. Providers should exercise caution when discussing CRDs with youth and families, particularly when considering CRDs for youth at elevated risk for eating disordered behavior.
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Affiliation(s)
- Katherine A S Gallagher
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030, USA
| | - Daniel DeSalvo
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin Street, Suite 1020, Houston, TX, 77030, USA
| | - Justin Gregory
- Vanderbilt University School of Medicine, 1500 21st Ave, Suite 1514, Nashville, TN, 37212, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave, Suite 940, Houston, TX, 77030, USA.
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26
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Wisting L, Rø A, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control. J Health Psychol 2019; 26:688-700. [DOI: 10.1177/1359105319840688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.
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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, Norway
| | - Astrid Rø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, 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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27
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Troncone A, Cascella C, Chianese A, Zanfardino A, Confetto S, Piscopo A, Iafusco D. Parental assessment of disordered eating behaviors in their children with type 1 diabetes: A controlled study. J Psychosom Res 2019; 119:20-25. [PMID: 30947813 DOI: 10.1016/j.jpsychores.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this research is to examine the presence of disordered eating behaviors (DEBs) in youths with type 1 diabetes (T1D) according to their parents' evaluations. The roles of demographic and diabetes-related variables were also analyzed. METHODS In 54 patients with T1D (aged 10.07-15.08) and in 54 age- and gender-matched healthy controls, DEBs were assessed using a parent-report standardized measure. BMI was calculated from height and weight. Glycemic control was assessed based on the most recent glycosylated hemoglobin value (HbA1c). The association of demographic and clinical factors with DEBs was evaluated through correlation and linear regression analyses. RESULTS DEBs were observed more frequently in participants with T1D (33.3%) than in controls (11%) (χ2 = 6.501, p = .04). The clinical sample obtained a higher score than controls in PEBEQ total score (t(106) = 2.464, p = .01), as well as in the Exaggerated interest in food (t(106) = 2.723, p = .008) and Rejection/disinterest in food subscales (t(106) = 2.216, p = .01). No gender differences were observed. In participants with T1D, but not in controls, PEBEQ total score was positively correlated with age (r = 0.203, p = .04), HbA1c (r = 0.335, p = .01), and zBMI (r = 0.298, p = .002); HbA1c (standardized beta =0.284, p = .04) was found to uniquely predict the PEBEQ total score. CONCLUSION Parents' evaluations may contribute to prompt detection of DEBs, which is crucial in developing appropriate strategies for timely intervention, especially during adolescence.
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28
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Wisting L, Wonderlich J, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Psychometric properties and factor structure of the diabetes eating problem survey - revised (DEPS-R) among adult males and females with type 1 diabetes. J Eat Disord 2019; 7:2. [PMID: 30675355 PMCID: PMC6337821 DOI: 10.1186/s40337-018-0232-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although an increasing amount of research has now established good psychometric properties and a three-component factor structure of the Diabetes Eating Problem Survey - Revised (DEPS-R) in pediatric samples with type 1 diabetes (T1D), research using adult samples has been limited and divergent. This study therefore aimed to investigate psychometric properties and test a three-factor model of the DEPS-R among adults with T1D. METHODS A total of 282 adults with T1D aged 18-79 years participated in the study. Measures included the DEPS-R, the Eating Disorder Examination Questionnaire (EDE-Q), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. RESULTS The DEPS-R total mean score (SD) for the total sample, males, and females were 13.8 (9.2), 11.2 (7.8), and 15.6 (9.6) respectively. Good fit indices for the confirmatory factor analysis were found. The Cronbach's alpha of the DEPS-R was .84, suggesting good internal consistency. The DEPS-R correlated significantly with the EDE-Q among both males (.52, p < .01) and females (.68, p < .001). Also, the DEPS-R correlated significantly with BMI in both genders (.33, p < .001 in females and .35, p < .001 in males). HbA1c correlated significantly with the DEPS-R in females (.27, p < .01), but not in males. CONCLUSIONS Good fit for a three-factor structure of the DEPS-R was confirmed. Further, the DEPS-R demonstrated good psychometric properties among adults with T1D, and can be recommended for clinical use for this patient group.
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Affiliation(s)
- Line Wisting
- 1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Joseph Wonderlich
- 3Department of Psychology, George Mason University, Fairfax, VA 22030 USA
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,4Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,5Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway.,The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,4Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,5Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway.,The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Øyvind Rø
- 1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,7Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
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29
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Shah VN, Wu M, Polsky S, Snell-Bergeon JK, Sherr JL, Cengiz E, DiMeglio LA, Pop-Busui R, Mizokami-Stout K, Foster NC, Beck RW. Gender differences in diabetes self-care in adults with type 1 diabetes: Findings from the T1D Exchange clinic registry. J Diabetes Complications 2018; 32:961-965. [PMID: 30121205 DOI: 10.1016/j.jdiacomp.2018.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/11/2023]
Abstract
AIMS To evaluate gender differences in diabetes self-care components including glycemic, blood pressure and lipid control, utilization of diabetes technologies and acute diabetes complications in adults with type 1 diabetes. METHODS A total of 9,481 participants >18 years were included in the analysis, 53% were female. Variables of interest included glycemic control measured by HbA1c, systolic/diastolic blood pressures, presence of dyslipidemia, insulin delivery modality, and rates of acute complications. RESULTS Glycemic control was similar in women and men (mean HbA1c in both groups: 8.1% ± 1.6% (64 ± 16 mmol/mol), (p = 0.54). More women used insulin pump therapy (66% vs. 59%, p < 0.001) but use of sensor technology was similar (p < = 0.42). Women had higher rates of diabetic ketoacidosis (DKA) (5% vs. 3%, p < 0.001) and eating disorders (1.7% vs. 0.1%, p < 0.001). Severe hypoglycemia rates were not different between men and women (p = 0.42). Smoking (6% vs 4%, p < 0.001), systolic (125 ± 14.2 vs. 121 ± 14.4, p < 0.001) and diastolic blood pressure (73.3 ± 9.5 vs. 72.2 ± 9.3, p < 0.001) and rate of dyslipidemia (28% vs. 23%, p < 0.001) were higher in men. CONCLUSION While glycemic control in type 1 diabetes was similar regardless of gender, rates of DKA and eating disorders were higher in women while rates of smoking, hypertension and dyslipidemia were higher in men.
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, Aurora, CO 80045, United States of America
| | - Mengdi Wu
- Jaeb Center for Health Research, Tampa, FL, United States of America.
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, Aurora, CO 80045, United States of America
| | | | - Jennifer L Sherr
- Yale School of Medicine, New Haven, CT, United States of America
| | - Eda Cengiz
- Yale School of Medicine, New Haven, CT, United States of America
| | - Linda A DiMeglio
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | | | | | - Nicole C Foster
- Jaeb Center for Health Research, Tampa, FL, United States of America
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, United States of America
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30
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Wisting L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Prevalence of disturbed eating behavior and associated symptoms of anxiety and depression among adult males and females with type 1 diabetes. J Eat Disord 2018; 6:28. [PMID: 30214804 PMCID: PMC6131775 DOI: 10.1186/s40337-018-0209-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/27/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The increased prevalence of disturbed eating behaviors (DEB), depression, and anxiety in type 1 diabetes (T1D) is generally well established; however the majority of existing research to date has focused on female adolescents and young adults. Data on males and older females is scarce. The aim of this study was to assess prevalence of DEB and symptoms of depression and anxiety among adult males and females with type 1 diabetes, to investigate differences between individuals scoring below and above the cut-off on psychopathology, and to examine patterns of eating disorder psychopathology by age and weight. METHODS A total of 282 adults with type 1 diabetes aged 18-79 years participated in the study. Measures included the Diabetes Eating Problem Survey - Revised (DEPS-R), the Hospital Anxiety and Depression Scale (HADS), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. RESULTS A total of 20.3% of the whole sample (13.3% among males and 24.8% among females) scored above the DEPS-R cut-off score for DEB. As for depression and anxiety, the prevalence in the whole sample was 6.2% and 19.0%, respectively. The prevalence was generally higher in females than males across all psychopathology measures. HbA1c was significantly associated with the DEPS-R total score (p < .01) among females, but not with depression and anxiety. Mean DEPS-R score decreased with increasing age, and when our previous reported data from children and adolescents are included, a peak prevalence in DEB in adolescence and young adult age is demonstrated. CONCLUSIONS The results of this study point to the need for increased awareness of psychological comorbidity among adults with type 1 diabetes, in particular young adult females. Screening is recommended to secure early detection and subsequent intervention for these individuals.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
- The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
- The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
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31
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Cherubini V, Skrami E, Iannilli A, Cesaretti A, Paparusso AM, Alessandrelli MC, Carle F, Ferrito L, Gesuita R. Disordered eating behaviors in adolescents with type 1 diabetes: A cross-sectional population-based study in Italy. Int J Eat Disord 2018; 51:890-898. [PMID: 30033602 DOI: 10.1002/eat.22889] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the association of clinical, metabolic and socioeconomic factors with disordered eating behaviors (DEB) among adolescents with type 1 diabetes screened using the Diabetes Eating Problem Survey-Revised (DEPS-R). METHODS A cross-sectional, population-based study involved 163 adolescents with type 1 diabetes, aged 11-20 years, recruited from the registry for type 1 diabetes of Marche Region, Italy, who completed the DEPS-R (response rate 74.4%). Clinical characteristics, lipid profile, HbA1c , family profile of education and occupation were evaluated. The Italian version of DEPS-R was validated, and the prevalence of DEB estimated. The association of demographic, socioeconomic, and clinical factors with DEB was evaluated by multiple correspondence analysis and multiple logistic regression. RESULTS The prevalence of DEPS-R-positive (score ≥20) was 27% (95% CI 17-38) in boys and 42% (95% CI 31-53) in girls. A clinical profile of DEPS-R-positive was identified: overweight, little time spent in physical activity, low socioeconomic status, poor metabolic control, skipping insulin injections. Furthermore, the probability of DEPS-R-positive increased 63% for every added unit of HbA1c , 36% for every added number of insulin injections skipped in a week and decreased about 20% for every added hour/week spent in physical activity. Overweight youth were six times more likely to be DEPS-R-positive. DISCUSSION A specific clinical profile of DEPS-R-positive was identified. A multidisciplinary clinical approach aimed to normalize eating behaviors and enhance self-esteem should be used to prevent the onset of these behaviors, and continuous educational programs are needed to promote healthy behaviors and lifestyles.
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Affiliation(s)
- Valentino Cherubini
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Edlira Skrami
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Iannilli
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Alessandra Cesaretti
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Anna Maria Paparusso
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | | | - Flavia Carle
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia Ferrito
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Università Politecnica delle Marche, Ancona, Italy
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32
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Grose DN, O'Brien CL, Castle DJ. Type 1 diabetes and an insulin pump: an iterative review of qualitative literature. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel N Grose
- St Vincent's Clinical School, Melbourne Medical School; The University of Melbourne; Parkville Victoria Australia
- St Vincent's Mental Health Service; St Vincent's Hospital Melbourne; Fitzroy Victoria Australia
| | - Casey L O'Brien
- St Vincent's Mental Health Service; St Vincent's Hospital Melbourne; Fitzroy Victoria Australia
- Department of Psychiatry; The University of Melbourne; Fitzroy Victoria Australia
| | - David J Castle
- St Vincent's Mental Health Service; St Vincent's Hospital Melbourne; Fitzroy Victoria Australia
- Department of Psychiatry; The University of Melbourne; Fitzroy Victoria Australia
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33
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Araia E, Hendrieckx C, Skinner T, Pouwer F, Speight J, King RM. Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth-Australia. Int J Eat Disord 2017; 50:1183-1193. [PMID: 28856699 DOI: 10.1002/eat.22746] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine gender differences in disordered eating behaviors (DEB) and body dissatisfaction in adolescents with type 1 diabetes. While evidence shows that female youth with type 1 diabetes are more prone to DEB compared to their peers without diabetes, little is known about male adolescents. METHOD In a national online survey, adolescents (13-19 years) with type 1 diabetes for ≥1 year completed the Diabetes Eating Problem Survey-Revised (DEPS-R), and the Body Mass Index Silhouette Matching Test (BMI-SMT) and items on binge eating and insulin omission. RESULTS About 477 adolescents (mean age 16 years; 62% females) completed the DEPS-R and 431 the BMI-SMT. The DEPS-R total score was higher for females than males, with scores for females increasing with age. BMI, HbA1c , insulin omission, and binge-eating frequency were associated moderately with DEPS-R for both genders. On the BMI-SMT, 88% of females wanted to be thinner. Of the males, 76% reported body dissatisfaction; however, only 43% expressed a desire for thinness with the remainder desiring a larger body size. DEPS-R was positively associated with the discrepancy between perceived actual and ideal body size for both genders. DISCUSSION A large proportion of adolescents with type 1 diabetes, particularly females reported engaging in DEB. Similarly, high rates of body dissatisfaction were reported, though ideal body shape preferences differed by gender. Given the high levels of self-reported DEB and gender-based patterns of body dissatisfaction, future research needs to examine the effectiveness of routine screening of DEB and consider implementation of stepped care approaches.
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Affiliation(s)
- Emanuala Araia
- School of Psychology, Deakin University, Geelong, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Melbourne, Diabetes Victoria, Australia
| | - Timothy Skinner
- School of Psychology and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Frans Pouwer
- Department of Psychology, South Danish University, Odense, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Melbourne, Diabetes Victoria, Australia.,AHP Research, Hornchurch, United Kingdom
| | - Ross M King
- School of Psychology, Deakin University, Geelong, Australia
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34
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Pinna F, Diana E, Sanna L, Deiana V, Manchia M, Nicotra E, Fiorillo A, Albert U, Nivoli A, Volpe U, Atti AR, Ferrari S, Medda F, Atzeni MG, Manca D, Mascia E, Farci F, Ghiani M, Cau R, Tuveri M, Cossu E, Loy E, Mereu A, Mariotti S, Carpiniello B. Assessment of eating disorders with the diabetes eating problems survey - revised (DEPS-R) in a representative sample of insulin-treated diabetic patients: a validation study in Italy. BMC Psychiatry 2017; 17:262. [PMID: 28724422 PMCID: PMC5518128 DOI: 10.1186/s12888-017-1434-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 07/13/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate in a sample of insulin-treated diabetic patients, with type 1 or type 2 diabetes, the psychometric characteristics of the Italian version of the DEPS-R scale, a diabetes-specific self-report questionnaire used to analyze disordered eating behaviors. METHODS The study was performed on 211 consecutive insulin-treated diabetic patients attending two specialist centers. Lifetime prevalence of eating disorders (EDs) according to DSM-IV and DSM-5 criteria were assessed by means of the Module H of the Structured Clinical Interview for DSM IV Axis I Disorder and the Module H modified, according to DSM-5 criteria. The following questionnaires were administered: DEPS-R and the Eating Disorder Inventory - 3 (EDI-3). Test/retest reproducibility was assessed on a subgroup of 70 patients. The factorial structure, internal consistency, test-retest reliability and concurrent validity of DEPS-R were assessed. RESULTS Overall, 21.8% of the sample met criteria for at least one DSM-5 diagnosis of ED. A "clinical risk" of ED was observed in 13.3% of the sample. Females displayed higher scores at DEPS-R, a higher percentage of at least one diagnosis of ED and a higher clinical risk for ED. A high level of reproducibility and homogeneity of the scale were revealed. A significant correlation was detected between DEPS-R and the 3 ED risk scales of EDI-3. CONCLUSIONS The data confirmed the overall reliability and validity of the scale. In view of the significance and implications of EDs in diabetic patients, it should be conducted a more extensive investigation of the phenomenon by means of evaluation instruments of demonstrated validity and reliability.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
| | - Enrica Diana
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Lucia Sanna
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Valeria Deiana
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy ,0000 0004 1936 8200grid.55602.34Department of Pharmacology, Dalhousie University, Halifax, NS Canada
| | - Eraldo Nicotra
- 0000 0004 1755 3242grid.7763.5Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Andrea Fiorillo
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Umberto Albert
- 0000 0001 2336 6580grid.7605.4Rita Levi Montalcini Department of Neuroscience, Anxiety and Mood Disorders Unit, University of Turin, Turin, Italy
| | - Alessandra Nivoli
- 0000 0001 2097 9138grid.11450.31Psychiatric Institute, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Umberto Volpe
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Anna Rita Atti
- 0000 0004 1757 1758grid.6292.fDepartment of Biomedical and Neuro Motor Sciences, University of Bologna, Bologna, Italy
| | - Silvia Ferrari
- 0000000121697570grid.7548.eDepartment of Diagnostic-Clinical Medicine and Public Health, University of Modena & Reggio Emilia, Modena, Italy
| | - Federica Medda
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Gloria Atzeni
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Daniela Manca
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Elisa Mascia
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Fernando Farci
- Unit of Diabetology, ASL-Cagliari, Quartu Sant’Elena, Italy
| | | | - Rossella Cau
- Unit of Diabetology, ASL-Cagliari, Quartu Sant’Elena, Italy
| | - Marta Tuveri
- Endocrinology and Diabetes Unit, AOU-Cagliari, Monserrato, Italy
| | - Efisio Cossu
- Endocrinology and Diabetes Unit, AOU-Cagliari, Monserrato, Italy
| | - Elena Loy
- Endocrinology and Diabetes Unit, AOU-Cagliari, Monserrato, Italy
| | - Alessandra Mereu
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Stefano Mariotti
- Endocrinology and Diabetes Unit, AOU-Cagliari, Monserrato, Italy ,0000 0004 1755 3242grid.7763.5Department of Medical Sciences, University of Cagliari, Monserrato, Italy
| | - Bernardo Carpiniello
- 0000 0004 1755 3242grid.7763.5Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
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Eating patterns in adolescents with type 1 diabetes: Associations with metabolic control, insulin omission, and eating disorder pathology. Appetite 2017; 114:226-231. [DOI: 10.1016/j.appet.2017.03.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022]
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Translation and validation of the Diabetes Eating Problem Survey to screen eating disorders in patients with type-1 diabetes mellitus. Med Clin (Barc) 2017; 148:548-554. [PMID: 28238335 DOI: 10.1016/j.medcli.2016.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The treatment of type-1 diabetes mellitus (T1DM) requires changes in patients' eating habits and lifestyles which could lead to the development of an eating disorder (ED). An early detection of these disorders in subjects with T1DM is necessary. However, there is no specific questionnaire concerning the presence of an ED in these patients. OBJECTIVES To translate and validate for the Spanish population a specific questionnaire aimed at detecting the risk of onset of an ED on a sample of subjects with T1DM. To analyze its agreement with its shortened version and with the gold standard tool, EAT-26. MATERIAL AND METHODS Cross-sectional study. The study population consisted of 112 adults with T1DM. The EAT-26 tool and DEPS-R questionnaire were used to detect subjects at risk for developing ED. In addition, several characteristics such as weight, height, BMI, age and age of onset were assessed by means of self-administered questionnaires, in order to study their correlation with test scoring. RESULTS Structural properties of the tests were evaluated through methodological procedures aimed at calculating reliability and validity. The translated and adapted version had a high consistency in both its complete and summarized version (α=0,821).The test-retest also yielded consistent results (intraclass correlation coefficient 95.8% for EPAD and 92.3% for EPAD-R). The factor analysis yielded 5 factors: 1) Eating attitudes; 2) Bulimic behavior; 3) Weight control; 4) Avoidance, and 5) Restriction. CONCLUSIONS We have developed a questionnaire in Spanish capable of identifying the risk of onset of a specific ED in patients with T1DM. The EPAD-R questionnaire detected 10% more cases and different ones than those detected by the EAT-26 test. It is necessary to use specific screening tools to correctly identify eating disorders in patients with T1DM.
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Gagnon C, Aimé A, Bélanger C. Predictors of Comorbid Eating Disorders and Diabetes in People with Type 1 and Type 2 Diabetes. Can J Diabetes 2017; 41:52-57. [DOI: 10.1016/j.jcjd.2016.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/28/2016] [Accepted: 06/24/2016] [Indexed: 01/29/2023]
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Complexity in eating disorders: a case for simple or complex formulation and treatment? COGNITIVE BEHAVIOUR THERAPIST 2017. [DOI: 10.1017/s1754470x17000162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractEating disorders are commonly regarded as complex psychiatric conditions, although this perception might be a product of the high levels of physical and psychological co-morbidity that are present in many such cases, rather than being about complexity in the eating disorderper se. This paper will consider the reasons that eating disorders are seen as complex, and whether or not that perceived complexity should be seen as a genuine reason to deviate from existing evidence-based cognitive behavioural therapy (CBT) protocols. Case examples will be used to illustrate how complex presentations can require clinicians to work skilfully with relatively simple formulations to achieve the best outcome, rather than using unnecessarily complex formulations and treatments. The importance of clear supervision is also stressed, as it can play a role in clinicians’ perception of the need for a complex or simple formulation, it can support the clinician in developing a collaborative, focused and efficient formulation, and it can keep the clinician on track with an evidence-based CBT approach.
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Wisting L, Bang L, Natvig H, Skrivarhaug T, Dahl-Jørgensen K, Lask B, Rø Ø. Metabolic Control and Illness Perceptions in Adolescents with Type 1 Diabetes. J Diabetes Res 2016; 2016:3486094. [PMID: 26682231 PMCID: PMC4670664 DOI: 10.1155/2016/3486094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/30/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Disturbed eating behavior and psychosocial variables have been found to influence metabolic control, but little is known about how these variables interact or how they influence metabolic control, separately and combined. OBJECTIVE To explore associations between metabolic control (measured by HbA1c) and eating disorder psychopathology, coping strategies, illness perceptions, and insulin beliefs in adolescents with type 1 diabetes. METHODS A total of 105 patients (41.9% males) with type 1 diabetes (12-20 years) were interviewed with the Child Eating Disorder Examination. In addition, self-report psychosocial questionnaires were completed. Clinical data, including HbA1c, was obtained from the Norwegian Childhood Diabetes Registry. RESULTS Significant gender differences were demonstrated. Among females, HbA1c correlated significantly with eating restriction (.29, p < .05), the illness perception dimensions consequences, personal control, coherence, and concern (ranging from .33 to .48), and the coping strategy ventilating negative feelings (-.26, p < .05). Illness perception personal control contributed significantly to HbA1c in a regression model, explaining 23% of the variance among females (β .48, p < .001). None of the variables were significantly associated with HbA1c among males. CONCLUSIONS Illness perceptions appear to be important contributors to metabolic control in females, but not males, with type 1 diabetes.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- *Line Wisting:
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Henrik Natvig
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Torild Skrivarhaug
- The Norwegian Childhood Diabetes Registry, Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Rhodes Farm Clinic, The Ridgeway, Barnet, London NW7 1RH, UK
- Gt. Ormond St. Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
- Department of Psychology, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039, Blindern, 0315 Oslo, Norway
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Saßmann H, Albrecht C, Busse-Widmann P, Hevelke LK, Kranz J, Markowitz JT, Marshall LF, Meurs S, de Soye IH, Lange K. Psychometric properties of the German version of the Diabetes Eating Problem Survey-Revised: additional benefit of disease-specific screening in adolescents with Type 1 diabetes. Diabet Med 2015; 32:1641-7. [PMID: 25919651 DOI: 10.1111/dme.12788] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 12/15/2022]
Abstract
AIM To examine the psychometric properties of the German version of the abbreviated 16-item Diabetes Eating Problem Survey-Revised in a sample of young people with Type 1 diabetes. METHODS A total of 246 young people, aged 11-19 years, with Type 1 diabetes from six pediatric diabetes centres in Germany were assessed using the Diabetes Eating Problem Survey-Revised. In addition, they underwent screening with two generic tools as well as the WHO five-question well-being index. A clinician's report was also obtained. RESULTS The Diabetes Eating Problem Survey-Revised was found to have good internal consistency (Cronbach's α = 0.84). The Diabetes Eating Problem Survey-Revised scores significantly correlated with those provided by the non-specific screening tools (r = 0.37, P ≤ 0.000 and r = 0.50, P ≤ 0.000 for boys and r = 0.62, P ≤ 0.000 and r = 0.79, P ≤ 0.000 for girls), indicating convergent validity. The mean (sd) total of the scores was 12.0 (9.6). Criterion validity was confirmed against HbA1c value, BMI standard deviation score and expert (clinician) report. Of the boys included in the study, 11 scored higher than the threshold score on the Diabetes Eating Problem Survey-Revised, of whom only three (27%) were classified as 'suspected to have a disordered eating behaviour' by their clinicians. CONCLUSIONS The Diabetes Eating Problem Survey-Revised delivered more specific information than generic screening instruments and identified more young people with eating disorders than did clinician report, especially regarding the detection of boys at risk. The results of this study support the utility of the German version of the Diabetes Eating Problem Survey-Revised to identify eating disorders in young people with Type 1 diabetes at an early stage. (German Clinical Trials Registry no.: DRKS00004699).
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Affiliation(s)
- H Saßmann
- Hannover Medical School, Medical Psychology, Hannover, Germany
| | - C Albrecht
- Clinical Centre Augsburg, Clinic for Children and Juveniles, Bunter Kreis GmbH, Team Diabetes, Augsburg, Germany
| | - P Busse-Widmann
- Dritter Orden Clinic Munich, Paediatric and Youth Medicine Clinic, Munich, Germany
| | - L K Hevelke
- Hannover Medical School, Medical Psychology, Hannover, Germany
| | - J Kranz
- University of Tübingen, Children's Hospital, Department III, Tübingen, Germany
| | - J T Markowitz
- Joslin Diabetes Center, Pediatric, Adolescent, and Young Adult Section, Boston, MA, USA
| | - L F Marshall
- University Medical Centre Schleswig Holstein Lübeck, Hospital for Child and Adolescent Medicine, Lübeck, Germany
| | - S Meurs
- Children's Hospital Passau Dritter Orden, Social Paediatric Centre, Passau, Germany
| | - I H de Soye
- Clinical Centre Nürnberg Süd, Children's Hospital, Nürnberg, Germany
| | - K Lange
- Hannover Medical School, Medical Psychology, Hannover, Germany
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Wisting L, Bang L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Adolescents with Type 1 Diabetes--The Impact of Gender, Age, and Health-Related Functioning on Eating Disorder Psychopathology. PLoS One 2015; 10:e0141386. [PMID: 26529593 PMCID: PMC4631487 DOI: 10.1371/journal.pone.0141386] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate correlates of eating disorder psychopathology in adolescent males and females with type 1 diabetes. Method A total of 105 adolescents with type 1 diabetes (42% males), aged 12–20 years, were recruited from the Norwegian Childhood Diabetes Registry in this population-based study. All participants were interviewed with the Child Eating Disorder Examination. Additionally, the Brief Illness Perception Questionnaire, the Adolescent Coping Orientation for Problem Experiences and the Beliefs about Medicines Questionnaire were administered to assess health-related functioning. Clinical data were obtained from the Norwegian Childhood Diabetes Registry. Results Significant gender differences were demonstrated in the pattern of correlates of eating disorder pathology. Among females, eating disorder psychopathology was significantly associated with body mass index adjusted for age and gender, age, insulin restriction, coping, illness perceptions, and perceptions of insulin concern. In a regression model, age, illness perceptions, and insulin restriction remained significantly associated with eating disorder psychopathology, explaining 48% of the variance. None of the variables were associated with eating disorder psychopathology among males. Discussion Greater clinical awareness of illness perceptions, attitudes toward insulin, and insulin restriction may potentially decrease the risk of developing eating disorders among female adolescents with type 1 diabetes, and the subsequent increased morbidity and mortality associated with comorbid type 1 diabetes and eating disorders.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Oslo, Norway
- * E-mail:
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- The Norwegian Childhood Diabetes Registry, Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Merwin RM, Dmitrieva NO, Honeycutt LK, Moskovich AA, Lane JD, Zucker NL, Surwit RS, Feinglos M, Kuo J. Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology. Diabetes Care 2015; 38:2025-32. [PMID: 26384389 PMCID: PMC4876774 DOI: 10.2337/dc15-0753] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/14/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Individuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions. RESEARCH DESIGN AND METHODS Eighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed 3 days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction. RESULTS Individuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual's typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., "no desserts"). CONCLUSIONS Results suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.
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Affiliation(s)
| | | | | | | | | | - Nancy L Zucker
- Duke University Medical Center, Durham, NC Duke University, Durham, NC
| | - Richard S Surwit
- Duke University Medical Center, Durham, NC Duke University, Durham, NC
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Colton PA, Olmsted MP, Daneman D, Farquhar JC, Wong H, Muskat S, Rodin GM. Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence. Diabetes Care 2015; 38:1212-7. [PMID: 25887359 DOI: 10.2337/dc14-2646] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/08/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Girls and women with type 1 diabetes are at increased risk for developing eating disorders (EDs), and these disorders are associated with serious diabetes-related medical complications. This study describes the longitudinal course of disturbed eating behavior (DEB) and EDs in a cohort with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 126 girls with type 1 diabetes receiving care for diabetes at The Hospital for Sick Children in Toronto participated in a series of seven interview-based assessments of ED behavior and psychopathology over a 14-year period, beginning in late childhood. Survival analysis was used. RESULTS Mean age was 11.8 ± 1.5 years at time 1 and 23.7 ± 2.1 years at time 7. At time 7, 32.4% (23/71) met the criteria for a current ED, and an additional 8.5% (6/71) had a subthreshold ED. Mean age at ED onset (full syndrome or below the threshold) was 22.6 years (95% CI 21.6-23.5), and the cumulative probability of onset was 60% by age 25 years. The average time between onset of ED and subsequent ED remission was 4.3 years (95% CI 3.1-5.5), and the cumulative probability of remission was 79% by 6 years after onset. The average time between remission of ED and subsequent recurrence was 6.5 years (95% CI 4.4-8.6), and the cumulative probability of recurrence was 53% by 6 years after remission. CONCLUSIONS In this longitudinal study, EDs were common and persistent, and new onset of ED was documented well into adulthood. Further research regarding prevention and treatment for this vulnerable group is urgently needed.
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Affiliation(s)
- Patricia A Colton
- Department of Psychiatry, University Health Network, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Marion P Olmsted
- Department of Psychiatry, University Health Network, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Denis Daneman
- The Hospital for Sick Children, Toronto, Canada Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jamie C Farquhar
- Department of Psychiatry, University Health Network, Toronto, Canada
| | - Harmonie Wong
- Department of Psychiatry, University Health Network, Toronto, Canada
| | - Stephanie Muskat
- Department of Psychiatry, University Health Network, Toronto, Canada
| | - Gary M Rodin
- Department of Psychiatry, University Health Network, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
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Colton PA, Olmsted MP, Wong H, Rodin GM. Eating disorders in individuals with type 1 diabetes: case series and day hospital treatment outcome. EUROPEAN EATING DISORDERS REVIEW 2015; 23:312-7. [PMID: 25988537 DOI: 10.1002/erv.2365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/18/2015] [Accepted: 04/18/2015] [Indexed: 11/09/2022]
Abstract
Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990-2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes (χ(2) = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high-risk group.
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Affiliation(s)
- Patricia Anne Colton
- Eating Disorder Program, University Health Network, and Department of Psychiatry, University of Toronto, Canada
| | | | - Harmonie Wong
- Psychosocial Oncology and Palliative Care, University Health Network, and Shirley Lederman Professor of Psychiatry, University of Toronto, Canada
| | - Gary Michael Rodin
- Psychosocial Oncology and Palliative Care, University Health Network, and Shirley Lederman Professor of Psychiatry, University of Toronto, Canada
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Welch E, Ghaderi A, Swenne I. A comparison of clinical characteristics between adolescent males and females with eating disorders. BMC Psychiatry 2015; 15:45. [PMID: 25885652 PMCID: PMC4359485 DOI: 10.1186/s12888-015-0419-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are serious disorders that have a negative impact on both the psychological and the physiological well-being of the afflicted. Despite the fact that ED affect both genders, males are often underrepresented in research and when included the sample sizes are often too small for separate analyses. Consequently we have an unclear and sometimes contradictory picture of the clinical characteristics of males with ED. The aim of the present study was to improve our understanding of the clinical features of adolescent males with eating disorders. METHODS We compared age at presentation, weight at presentation, history of significantly different premorbid weight and psychiatric (Attention Deficit Hyperactivity Disorder (ADHD)) and somatic comorbidity (celiac disease and diabetes) of 58 males to 606 females seeking medical care for eating disorders at the Children's Hospital in Uppsala, Sweden during the years 1999-2012. As all boys were diagnosed with either AN or Other Specified Feeding or Eating Disorder (OSFED) atypical AN, the age and weight comparisons were limited to those girls fulfilling the diagnostic criteria for AN or OSFED atypical AN. RESULTS There was no significant difference in age at presentation. Differences in weight at presentation and premorbid weight history were mixed. A significantly higher percentage of males had a history of a BMI greater than two standard deviations above the mean for their corresponding age group. As well, there was a higher prevalence of ADHD among the males whereas celiac disease and diabetes only was found among the females. CONCLUSIONS A better understanding of the clinical characteristics of males with ED at presentation should improve our ability to identify males with ED and thereby aid in tailoring the best treatment alternatives.
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Affiliation(s)
- Elisabeth Welch
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Dickens YL, Haynos AF, Nunnemaker S, Platka-Bird L, Dolores J. Multidisciplinary residential treatment of type 1 diabetes mellitus and co-occurring eating disorders. Eat Disord 2015; 23:134-43. [PMID: 25330352 PMCID: PMC4326542 DOI: 10.1080/10640266.2014.964609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Research on treatment for diabetes and co-occurring eating disorders is sparse. We examined outcomes from multidisciplinary residential treatment for women with type 1 diabetes and eating disorders and the impact of treatment duration on outcomes. Participants were 29 women with type 1 diabetes and eating disorders receiving residential treatment. Repeated measures analyses of variance examined changes in blood glucose and psychological symptoms over treatment. Analyses were repeated to include treatment by duration interactions. Treatment produced significant reductions in blood glucose, eating disorder symptoms, and psychological concerns. Longer treatment duration was associated with greater improvements in psychological symptoms.
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Affiliation(s)
- Yani L Dickens
- a Counseling Services, University of Nevada , Reno , Nevada , USA
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Merwin RM, Moskovich AA, Dmitrieva NO, Pieper CF, Honeycutt LK, Zucker NL, Surwit RS, Buhi L. Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes. Appetite 2014; 81:123-30. [PMID: 24882448 PMCID: PMC4130344 DOI: 10.1016/j.appet.2014.05.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 05/18/2014] [Accepted: 05/23/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c). METHODS Two-hundred and seventy-six individuals with type 1 diabetes completed an online survey of eating behaviors, insulin dosing and most recent HbA1c. We used structural equation modeling to test the hypothesis that disinhibited eating when blood sugar is thought to be low predicts weight-related insulin mismanagement, and this, in turn, predicts higher HbA1c. RESULTS The majority of participants endorsed some degree of disinhibition when they think their blood glucose is low (e.g., eating foods they do not typically allow) and corresponding negative affect (e.g., guilt/shame). The frequency of disinhibited eating was positively associated with weight-related insulin mismanagement. Controlling for age, sex, education, and insulin pump use, the model explained 31.3% of the variance in weight-related insulin mismanagement and 16.8% of the variance in HbA1c. CONCLUSION Addressing antecedents to disinhibited eating that are unique to type 1 diabetes (e.g., perceived BG level) and associated guilt or shame may reduce weight-related insulin omission.
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Affiliation(s)
- Rhonda M Merwin
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710.
| | - Ashley A Moskovich
- Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
| | - Natalia O Dmitrieva
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710
| | - Carl F Pieper
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710
| | - Lisa K Honeycutt
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710
| | - Nancy L Zucker
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710; Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
| | - Richard S Surwit
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710; Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
| | - Lori Buhi
- Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
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Zander H, Beneke J, Vagedes D, Müller A, de Zwaan M. Type 1 diabetes mellitus and bulimia nervosa: insulin restriction does not always represent purging of unwanted calories. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Heike Zander
- Department of Psychosomatic Medicine and Psychotherapy; Hannover Medical School; Hannover Germany
| | - Johannes Beneke
- Department of Psychosomatic Medicine and Psychotherapy; Hannover Medical School; Hannover Germany
| | - Daniel Vagedes
- Department of Clinical Immunology and Rheumatology; Hannover Medical School; Hannover Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy; Hannover Medical School; Hannover Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy; Hannover Medical School; Hannover Germany
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Troncone A, Prisco F, Cascella C, Chianese A, Zanfardino A, Iafusco D. The evaluation of body image in children with type 1 diabetes: A case-control study. J Health Psychol 2014; 21:493-504. [DOI: 10.1177/1359105314529682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the body image perception in children with type 1 diabetes in order to identify symptoms of disordered eating behaviours early. Children with type 1 diabetes and controls showed underestimation and dissatisfaction with body size. The patients, especially girls, were more accurate in their perception of body size than the control group. The study sheds light on some of the underlying factors that may contribute to the development of disordered eating behaviours in adolescence. The causes of the differences of perception of body size are discussed.
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McCarvill R, Weaver K. Primary care of female adolescents with type 1 diabetes mellitus and disordered eating. J Adv Nurs 2014; 70:2005-2018. [PMID: 24628439 DOI: 10.1111/jan.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
AIM To identify the role of the nurse practitioner in caring for female adolescents with type 1 diabetes mellitus at risk for disordered eating behaviour and to formulate clinical recommendations for nurse practitioners in the primary care setting. BACKGROUND Transition into adulthood can be difficult for female adolescents with type 1 diabetes mellitus. Challenges associated with management of this illness may place adolescent females at an increased risk for disordered eating. DESIGN Discussion paper. DATA SOURCES Sourced literature from 1991-2013, located through CINAHL, Health Source, Proquest, PubMed, PsychInfo, Web of Science and Medline databases. IMPLICATIONS FOR NURSING Nurses involved in the primary care of female adolescents with type 1 diabetes mellitus need to be aware of the increased risk for disordered eating behaviours and develop the competencies to care for both the adolescent and her family to reduce the serious consequences of these behaviours. CONCLUSION Awareness and acquisition of the skills required to intervene will enable nurse practitioners to recognize clients at risk for disordered eating, gain appreciation of the motivation of female adolescents with type 1 diabetes mellitus towards disordered eating behaviours and give optimal opportunity for education, counselling and recovery. Future direction for research includes exploration of the experiences of adolescents with type 1 diabetes mellitus; early interventions in the primary care setting; effective educational, preventative or supportive services for adolescents with this illness and their families; and outcomes to emerging technologies for insulin therapy on disordered eating occurrence.
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Affiliation(s)
| | - Kathryn Weaver
- University of New Brunswick, Fredericton, New Brunswick, Canada
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