1
|
Lan YY, Kovinthapillai R, Kędzia A, Niechciał E. Age-based challenges to type 1 diabetes management in the pediatric population. Front Pediatr 2024; 12:1434276. [PMID: 39286453 PMCID: PMC11402681 DOI: 10.3389/fped.2024.1434276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
Type 1 diabetes is rising in the pediatric population, affecting approximately 1.2 million children and adolescents globally. Its complex pathogenesis involves the interaction between genetic predisposition and environmental factors, leading to T cell-mediated destruction of insulin-producing pancreatic beta-cells. This destruction results in insulin insufficiency and hyperglycemia. Hence, managing type 1 diabetes requires a comprehensive approach that includes various aspects such as blood glucose monitoring, insulin therapy, carbohydrate counting, caloric intake monitoring, considering family habits and food preferences, planning daily schedules, and incorporating physical activity. Children with type 1 diabetes encounter age-specific challenges in disease management that may exacerbate the risk of metabolic complications and adverse health outcomes. These risk factors may be neurological, physiological, behavioral, psychological, or social, complicate management and necessitate tailored approaches for effective care. Regardless of the age group, primary caregivers have a high responsibility to maintain optimal glycemic control, including monitoring diet, daily activity, and administering insulin. By reviewing research on the challenges faced by pediatric patients with type 1 diabetes, we summarized key insights aimed at developing targeted interventions and support systems that enhance diabetes management and improve health outcomes in this vulnerable population.
Collapse
Affiliation(s)
- Yung-Yi Lan
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Rujith Kovinthapillai
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Kędzia
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - Elżbieta Niechciał
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
2
|
Goddard G, Oxlad M, Turnbull D. The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review. J Diabetes Metab Disord 2023; 22:13-34. [PMID: 37255778 PMCID: PMC10225459 DOI: 10.1007/s40200-022-01151-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
Background Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males' misuse of insulin for weight and/or shape control. Methods A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021. Results A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies). Conclusion Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01151-8.
Collapse
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
| |
Collapse
|
3
|
Tarçın G, Akman H, Güneş Kaya D, Serdengeçti N, İncetahtacı S, Turan H, Doğangün B, Ercan O. Diabetes-specific eating disorder and possible associated psychopathologies in adolescents with type 1 diabetes mellitus. Eat Weight Disord 2023; 28:36. [PMID: 37029851 PMCID: PMC10082703 DOI: 10.1007/s40519-023-01559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/13/2022] [Indexed: 04/09/2023] Open
Abstract
PURPOSE It was aimed to investigate the frequency of the risk of diabetes-specific eating disorder (DSED) in adolescents with type 1 diabetes mellitus (T1DM) and to reveal the accompanying psychopathologies. METHODS Adolescents with T1DM aged 12-18 who applied to the pediatric diabetes outpatient clinic between July 2021 and March 2022 were included. Diabetes Eating Problem Survey-Revised (DEPS-R) was applied to all patients to determine the risk of DSED. In order to detect accompanying psychopathologies, Eating Disorder Examination Questionnaire (EDE-Q), Child Anxiety and Depression Scale-Child version (RCADS) and Parenting Style Scale were applied. After completing the scales, semi-structured interviews were conducted with all patients by a child and adolescent psychiatrist. RESULTS Ninety-two adolescents (45 boys, 47 girls) were included. DSED risk was found in 23.9% of the cases. A positive correlation was found between DEPS-R and EDE-Q scores (p = 0.001, rho = 0.370). RCADS mean scores were significantly higher in the group with DSED risk (p < 0.001). When the Parenting Style Scale was evaluated, psychological autonomy scores were significantly lower in the group with DSED risk (p = 0.029). As a result of the psychiatric interviews, 30 (32.6%) patients had at least 1 psychiatric disorder. Of these, 2 patients were diagnosed with eating disorder. CONCLUSION Almost one-fourth of adolescents with T1DM were found to be at risk of DSED. Routine screening of adolescents with T1DM with the DEPS-R scale may provide early detection of DSED, and referral of those at risk to child psychiatry enables early diagnosis and intervention for both eating disorders and accompanying psychopathologies. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
Collapse
Affiliation(s)
- Gürkan Tarçın
- Department of Pediatric Endocrinology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hazal Akman
- Department of Child and Adolescent Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Didem Güneş Kaya
- Department of Pediatrics, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nihal Serdengeçti
- Department of Child and Adolescent Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sena İncetahtacı
- Department of Child and Adolescent Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hande Turan
- Department of Pediatric Endocrinology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burak Doğangün
- Department of Child and Adolescent Psychiatry, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Oya Ercan
- Department of Pediatric Endocrinology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| |
Collapse
|
4
|
MOJANİ QOMİ MS, HATAMİ M, ZİARATİ P. Evaluation of Eating Habits and Nutrient Intake in Adolescents with and without Suspected Eating Disorders in Iran. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2023. [DOI: 10.33808/clinexphealthsci.976389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Objective: Increasing the incidence of eating disorder (ED) attitude during adolescence may lead to inadequate nutrient intake and consequently to growth disorders. This study aimed to compare eating habits and nutrient intakes of adolescents with high risk and low risk of developing eating disorders in high schools in Tehran, Iran.
Methods: In the current cross-sectional study, the Eating Attitude Test (EAT-26) was applied to 299 students (185 females and 114 males) aged 15-18 years for the determination of ED attitudes. Food habits and nutrient intake were assessed by a self-administered questionnaire and a validated Food Frequency Questionnaire (FFQ), respectively. Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were calculated using nutrient’s Dietary Reference Intake (DRI) for age and sex.
Results: Of all students, 17.7% were at risk of developing ED. The results showed that girls, unlike boys, consumed more energy than they needed, but this difference between the ED group in both sexes was not significant. The distribution of sweetened drinks, candy, chocolate, and fast food frequency was significantly different between the two groups of girls (P
Collapse
|
5
|
Yahya AS, Khawaja S, Naguib M. ‘Diabulimia’: current insights into type 1 diabetes and bulimia nervosa. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2023. [DOI: 10.1002/pnp.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Ahmed Saeed Yahya
- Dr Yahya is a Consultant Psychiatrist at both the Priory Hospital North London and The Maudsley Hospital in South London; Dr Khawaja is a Consultant Psychiatrist and ECT Clinical Lead, and Dr Naguib is a Locum Consultant Psychiatrist, both at North East London NHS Foundation Trust
| | - Shakil Khawaja
- Dr Yahya is a Consultant Psychiatrist at both the Priory Hospital North London and The Maudsley Hospital in South London; Dr Khawaja is a Consultant Psychiatrist and ECT Clinical Lead, and Dr Naguib is a Locum Consultant Psychiatrist, both at North East London NHS Foundation Trust
| | - Meena Naguib
- Dr Yahya is a Consultant Psychiatrist at both the Priory Hospital North London and The Maudsley Hospital in South London; Dr Khawaja is a Consultant Psychiatrist and ECT Clinical Lead, and Dr Naguib is a Locum Consultant Psychiatrist, both at North East London NHS Foundation Trust
| |
Collapse
|
6
|
Oliveira Cunha MCS, Dutra FCS, Cavaleiro Brito LMM, Costa RF, Gaspar MWG, Sousa DF, Moura de Araújo MF, Queiroz MVO. Disordered eating behaviour and eating disorder among adolescents with type 1 diabetes: An integrative review. World J Meta-Anal 2022; 10:244-254. [DOI: 10.13105/wjma.v10.i5.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Type 1 diabetes (DT1) in adolescents brings behavioural changes, altered nutritional habits, and eating disorders.
AIM To identify and analyze the validated instruments that examine the disordered eating behaviour and eating disorders among adolescents with DT1.
METHODS An integrative review was accomplished based on the following databases: PubMed, LILACS, CINAHL, Scopus, Web of Science, and Reference Citation Analysis (RCA), including publications in Portuguese, English, or Spanish, without time limit and time published.
RESULTS The main instruments to evaluate disordered eating behaviour were The Diabetes Eating Problem Survey-Revised, The Diabetes Eating Problem Survey, and the eating attitudes test-26, and for eating disorders the main instruments used were The Bulimic Investigation Test of Edinburgh, The Binge Eating Scale, The Child Eating Disorder Examination, The five questions of the (Sick, Control, One, Fat and Food), and The Mind Youth Questionnaire. These instruments showed an effect in evaluating risks regarding nutritional habits or feeding grievances, with outcomes related to weight control, inadequate use of insulin, and glycaemia unmanageability. We did not identify publication bias.
CONCLUSION Around the world, the most used scale to study the risk of disordered eating behaviour or eating disorder is The Diabetes Eating Problem Survey-Revised. International researchers use this scale to identify high scores in adolescents with DT1 and a relationship with poorer glycemic control and psychological problems related to body image.
Collapse
Affiliation(s)
| | | | | | - Rejane Ferreira Costa
- Department of Health Family, Oswaldo Cruz Foundation, Eusébio 61773-272, Ceará, Brazil
| | - Maria Wendiane Gueiros Gaspar
- Department of Health Science, University for the International Integration of Afro-Brazilian Lusophony, Redenção 62790-000, Ceará, Brazil
| | - Danilo Ferreira Sousa
- Department of Nursing, University for the International Integration of Afro-Brazilian Lusophony, Redenção 62790-000, Brazil
| | | | | |
Collapse
|
7
|
Burahmah J, Zheng D, Leslie RD. Adult-onset type 1 diabetes: A changing perspective. Eur J Intern Med 2022; 104:7-12. [PMID: 35718648 DOI: 10.1016/j.ejim.2022.06.003] [Citation(s) in RCA: 4] [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] [Received: 02/01/2022] [Revised: 04/27/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022]
Abstract
Type 1 diabetes most commonly presents in adulthood, contrary to the widely held view that it is a disease of childhood. Furthermore, a substantial proportion of cases of adult-onset type 1 diabetes does not require insulin therapy at clinical onset. Recent studies have emphasised the evidence that adult-onset type 1 diabetes is prevalent but often misclassified initially as type 2 diabetes (1, 2). In this review, we discuss that recent literature, highlighting the similarities and differences between adult-onset and childhood-onset type 1 diabetes, exploring recent debates surrounding its epidemiology and genetics, as well as expanding on important issues of diagnostic criteria for individuals presenting with adult-onset diabetes and the subsequent management once identified as having an autoimmune basis. In addition, this review looks at the psychosocial challenges faced by T1D patients and their possible management.
Collapse
Affiliation(s)
- J Burahmah
- Blizard Institute, Queen Mary, London, UK
| | - D Zheng
- Blizard Institute, Queen Mary, London, UK
| | - R D Leslie
- Blizard Institute, Queen Mary, London, UK.
| |
Collapse
|
8
|
Nasrallah M, Tamim H, Mailhac A, AlBuhairan F. Lifestyle habits in Saudi adolescents with diagnosed diabetes: An opportunity for health promotion. PLoS One 2022; 17:e0270807. [PMID: 35925967 PMCID: PMC9352005 DOI: 10.1371/journal.pone.0270807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
Aims This study assessed lifestyle and health behavior habits among a representative sample of Saudi adolescents with self-reported diabetes and compared them to non-diabetic peers. Methods This was a nested case-control study, from the Jeeluna cohort, a nationwide, cross-sectional study of 12,575 Saudi boys and girls aged 10–19 years. Non-diabetic adolescents were matched to those with diabetes on a ratio of 4:1 based on age, gender and region. Retained information from the original study included: socio-demographics, lifestyle behaviors, tobacco/substance use, screen use, anthropometric measurements, and laboratory results. Results The prevalence of diabetes was 0.7% (n = 87). Overall, 65% of diabetic participants were males, and 22.4% aged ≤14 years. Overall, both groups had low rates of healthful habits in their diet and physical activity. Both groups had similar rates of tobacco use, and high digital screen time. Adolescents with diabetes had more consistent sleeping pattern, were more likely to be on a diet, thought they spent enough time with their physician and obtained medical information more often from their health clinic. They were also more likely to feel down and to chat more often. Conclusion Adolescents with diabetes remain far from guideline targets but seem predisposed to better lifestyle and have more access to health as compared to their non-diabetic peers.
Collapse
Affiliation(s)
- Mona Nasrallah
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadia AlBuhairan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Health Sector Transformation Program, Riyadh, Saudi Arabia
- * E-mail:
| |
Collapse
|
9
|
Salah NY, Hashim MA, Abdeen MSE. Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control. J Eat Disord 2022; 10:46. [PMID: 35379350 PMCID: PMC8981863 DOI: 10.1186/s40337-022-00571-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/24/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Disordered eating behaviour (DEB) represents a significant morbidity among people with type-1 diabetes (T1D). Continuous-subcutaneous insulin infusion (CSII) improves glycemic control and psychological wellbeing in those with T1D. However, its relation to DEB remains obscure. OBJECTIVES To compare DEB among adolescents with T1D on CSII versus basal-bolus regimen and correlate it with body image, HbA1C and depression. METHODS Sixty adolescents with T1D (30 on CSII and 30 on basal-bolus regimen), aged 12-17 years were studied focusing on diabetes-duration, insulin therapy, exercise, socioeconomic standard, hypoglycemic attacks/week and family history of psychiatric illness. Anthropometric measures, HbA1C, binge eating scale (BES), body image tool, patient health questionnaire-9 (PHQ9) and the Mini-KID depression scale were assessed. RESULTS Among the studied adolescents with T1D, six had DEB (10%), 14 had poor body-image perception (23.3%), 42 had moderate body-image perception (70%) and 22 had depression (36.7%). Adolescents with T1D on CSII had significantly lower BES (p = 0.022), Mini-KID depression (p = 0.001) and PHQ9 (p = 0.02) than those on basal-bolus regimen. BES was positively correlated to depression (p < 0.001), HbA1C (p = 0.013) and diabetes-duration (p = 0.009) and negatively correlated to body-image (p = 0.003). CONCLUSION DEB is a prevalent comorbidity among adolescents with T1D, with higher frequency in those on basal-bolus regimen than CSII.
Collapse
Affiliation(s)
- Nouran Yousef Salah
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, 25 Korash Street, Nasr City, Cairo, Egypt.
| | - Mostafa Ahmad Hashim
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | |
Collapse
|
10
|
Turan H, Güneş Kaya D, Tarçın G, Evliyaoğlu SO. Effect of the COVID-19 quarantine on metabolic control in children and adolescents with type 1 diabetes. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2022; 69:201-208. [PMID: 35396118 PMCID: PMC8982060 DOI: 10.1016/j.endien.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/14/2021] [Indexed: 11/24/2022]
Abstract
Introduction Metabolic control in type 1 diabetes (T1D) depends on many factors such as eating habits, exercise and lifestyle. The objective of this study was to investigate how these factors were affected during the coronavirus disease 2019 (COVID-19) lockdown and impacted metabolic control in children with T1D. Materials and method One hundred children with T1D were enrolled in the study. Anthropometric measurements, snack and meal frequency, carbohydrate consumption, HbA1c levels, and exercise patterns were recorded and compared before and after the lockdown. Subjects were divided into two subgroups—patients with decreased and patients with increased HbA1c levels after the lockdown—and comparisons of the same parameters were also made between these two subgroups. Results In the overall group, the mean HbA1c level was significantly higher after the lockdown compared to before (p = 0.035). Meal schedules changed due to delayed sleep and waking times, and total daily carbohydrate consumption increased in the subgroup with increased HbA1c while it decreased in the subgroup with decreased HbA1c (p < 0.001 for both). Conclusion Our study supports the notion that blood sugar management in children with T1D worsened during the COVID-19 pandemic. Although it is not possible to explain this with any one factor, some behavioral changes observed in our study, such as inactivity, irregular meal frequency and timing, and irregular sleep and waking patterns appeared to be associated with blood sugar management.
Collapse
|
11
|
Cristello Sarteau A, Mayer-Davis E. Too Much Dietary Flexibility May Hinder, Not Help: Could More Specific Targets for Daily Food Intake Distribution Promote Glycemic Management among Youth with Type 1 Diabetes? Nutrients 2022; 14:nu14040824. [PMID: 35215477 PMCID: PMC8877269 DOI: 10.3390/nu14040824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
Average glycemic levels among youth with type 1 diabetes (T1D) have worsened in some parts of the world over the past decade despite simultaneous increased uptake of diabetes technology, thereby highlighting the persistent need to identify effective behavioral strategies to manage glycemia during this life stage. Nutrition is fundamental to T1D management. We reviewed the evidence base of eating strategies tested to date to improve glycemic levels among youth with T1D in order to identify promising directions for future research. No eating strategy tested among youth with T1D since the advent of flexible insulin regimens—including widely promoted carbohydrate counting and low glycemic index strategies—is robustly supported by the existing evidence base, which is characterized by few prospective studies, small study sample sizes, and lack of replication of results due to marked differences in study design or eating strategy tested. Further, focus on macronutrients or food groups without consideration of food intake distribution throughout the day or day-to-day consistency may partially underlie the lack of glycemic benefits observed in studies to date. Increased attention paid to these factors by future observational and experimental studies may facilitate identification of behavioral targets that increase glycemic predictability and management among youth with T1D.
Collapse
Affiliation(s)
- Angelica Cristello Sarteau
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- Correspondence:
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- School of Medicine, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA
| |
Collapse
|
12
|
Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2021; 64:2609-2652. [PMID: 34590174 PMCID: PMC8481000 DOI: 10.1007/s00125-021-05568-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.
Collapse
Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Amy Hess-Fischl
- Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, Seattle, WA, USA
| | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
13
|
Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021; 44:2589-2625. [PMID: 34593612 DOI: 10.2337/dci21-0043] [Citation(s) in RCA: 217] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.
Collapse
Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K. .,Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, U.K
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands.,Profil Institute for Metabolic Research, Neuss, Germany
| | | | | | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | |
Collapse
|
14
|
Smigoc Schweiger D, Battelino T, Groselj U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. Int J Mol Sci 2021; 22:ijms221910192. [PMID: 34638531 PMCID: PMC8508122 DOI: 10.3390/ijms221910192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.
Collapse
Affiliation(s)
- Darja Smigoc Schweiger
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, 870 Quarry Road, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +386-1-522-9235; Fax: +386-1-232-0190
| |
Collapse
|
15
|
Turan H, Güneş Kaya D, Tarçın G, Evliyaoğlu SO. Effect of the COVID-19 quarantine on metabolic control in children and adolescents with type 1 diabetes. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00147-6. [PMID: 34274306 PMCID: PMC8842580 DOI: 10.1016/j.endinu.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Metabolic control in type 1 diabetes (T1D) depends on many factors such as eating habits, exercise and lifestyle. The objective of this study was to investigate how these factors were affected during the coronavirus disease 2019 (COVID-19) lockdown and impacted metabolic control in children with T1D. MATERIALS AND METHOD One hundred children with T1D were enrolled in the study. Anthropometric measurements, snack and meal frequency, carbohydrate consumption, HbA1c levels, and exercise patterns were recorded and compared before and after the lockdown. Subjects were divided into two subgroups-patients with decreased and patients with increased HbA1c levels after the lockdown-and comparisons of the same parameters were also made between these two subgroups. RESULTS In the overall group, the mean HbA1c level was significantly higher after the lockdown compared to before (p=0.035). Meal schedules changed due to delayed sleep and waking times, and total daily carbohydrate consumption increased in the subgroup with increased HbA1c while it decreased in the subgroup with decreased HbA1c (p<0.001 for both). CONCLUSION Our study supports the notion that blood sugar management in children with T1D worsened during the COVID-19 pandemic. Although it is not possible to explain this with any one factor, some behavioral changes observed in our study, such as inactivity, irregular meal frequency and timing, and irregular sleep and waking patterns appeared to be associated with blood sugar management.
Collapse
Affiliation(s)
- Hande Turan
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey.
| | - Didem Güneş Kaya
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric, Istanbul, Turkey
| | - Gürkan Tarçın
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Saadet Olcay Evliyaoğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| |
Collapse
|
16
|
Yu Y, Kalarchian MA, Ma Q, Groth SW. Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery. Surg Obes Relat Dis 2021; 17:976-985. [PMID: 33619009 DOI: 10.1016/j.soard.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/27/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating. OBJECTIVES To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients. SETTING Multicenter study, United States. METHODS This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating. RESULTS The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m2. The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05). CONCLUSION Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.
Collapse
Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | | | - Qianheng Ma
- School of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
| |
Collapse
|
17
|
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.
Collapse
|
18
|
Ayton A, Ibrahim A. The Western diet: a blind spot of eating disorder research?-a narrative review and recommendations for treatment and research. Nutr Rev 2020; 78:579-596. [PMID: 31846028 PMCID: PMC7682725 DOI: 10.1093/nutrit/nuz089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Over the last 50 years, in parallel with the obesity epidemic, the prevalence of eating disorders has increased and presentations have changed. In this narrative review, we consider recent research exploring the implications of changing patterns of food consumption on metabolic and neurobiological pathways, a hitherto neglected area in eating disorder research. One of the major changes over this time has been the introduction of ultra-processed (NOVA-4) foods, which are gradually replacing unprocessed and minimally processed foods. This has resulted in the increased intake of various sugars and food additives worldwide, which has important metabolic consequences: triggering insulin and glucose response, stimulating appetite, and affecting multiple endocrine and neurobiological pathways, as well as the microbiome. A paradigm shift is needed in the conceptual framework by which the vulnerability to, and maintenance of, different eating disorders may be understood, by integrating recent knowledge of the individual metabolic responses to modern highly processed foods into existing psychological models. This could stimulate research and improve treatment outcomes.
Collapse
Affiliation(s)
- Agnes Ayton
- University of Oxford, Oxford, United Kingdom
| | - Ali Ibrahim
- South London and Maudsley NHS Foundation Trust, Snowsfields Adolescent Unit, Mapother House, Maudsley Hospital, London
| |
Collapse
|
19
|
Christoforidis A, Kavoura E, Nemtsa A, Pappa K, Dimitriadou M. Coronavirus lockdown effect on type 1 diabetes management οn children wearing insulin pump equipped with continuous glucose monitoring system. Diabetes Res Clin Pract 2020; 166:108307. [PMID: 32650036 PMCID: PMC7340587 DOI: 10.1016/j.diabres.2020.108307] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/20/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
AIMS On the 10th of March, Greece imposed the closure of schools and universities and a full lockdown a few days later in order to counter the spread of the coronavirus outbreak. Our aim was to monitor the effect of the coronavirus lockdown in diabetes management in children with Type 1 Diabetes Mellitus (T1DM) wearing insulin pump equipped with continuous glucose monitoring system. METHODS In 34 children with T1DM on Medtronic 640G insulin pump equipped with the Enlite Sensor uploaded CareLink data were categorized in 2 three-week periods before and after the 10th of March. RESULTS Mean time in range (TIR) did not significantly differ between the two periods. However, a significantly higher Coefficient of Variation (CV) indicating an increased glucose variability in the pre-lockdown period was observed (39.52% versus 37.40%, p = 0.011). Blood glucose readings were significantly fewer during the lockdown period (7.91 versus 7.41, p = 0.001). No significant difference was recorded regarding the total daily dose of insulin and the reported carbohydrates consumed. However, the meal schedule has changed dramatically as the percentage of breakfast consumed before 10.00 a.m. has fallen from 80.67% to 41.46% (p < 0.001) during the lockdown. Correspondingly, the percentage of dinner consumption before 10.00 p.m. significantly fell during the lockdown period (60.22% versus 53.78%, p = 0.019). CONCLUSIONS Glycemic control during the coronavirus lockdown can be adequately achieved and be comparable to the pre-lockdown period in children with type 1 diabetes mellitus wearing insulin pump equipped with sensor.
Collapse
Affiliation(s)
- Athanasios Christoforidis
- 1st Paediatric Department, Aristotle University, Ippokration General Hospital, 49(th) Konstantinoupoleos str, P.C.: 54642, Thessaloniki, Greece.
| | - Evgenia Kavoura
- Medtronic Hellas S.A., 9th klm Thessaloniki-Moudianion, P.C.: 55535, Pilea, Greece
| | - Aggeliki Nemtsa
- 1st Paediatric Department, Aristotle University, Ippokration General Hospital, 49(th) Konstantinoupoleos str, P.C.: 54642, Thessaloniki, Greece
| | - Konstantina Pappa
- 1st Paediatric Department, Aristotle University, Ippokration General Hospital, 49(th) Konstantinoupoleos str, P.C.: 54642, Thessaloniki, Greece
| | - Meropi Dimitriadou
- 1st Paediatric Department, Aristotle University, Ippokration General Hospital, 49(th) Konstantinoupoleos str, P.C.: 54642, Thessaloniki, Greece
| |
Collapse
|
20
|
Ayar D, Ozturk C, Bektas M, Bober E, Grey M. The effect of metabolic control, self-efficacy, and quality of life on emotional eating in the adolescents with type 1 diabetes mellitus. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
21
|
Iqbal AM, Kumar S, Hansen J, Heyrman M, Spee R, Lteif A. Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes. CHILDREN 2020; 7:children7010008. [PMID: 31963630 PMCID: PMC7022250 DOI: 10.3390/children7010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
Abstract
Adverse childhood experiences (ACE) have been associated with a greater prevalence of risky behaviors and chronic health conditions, such as diabetes in adulthood. While adolescents with risk taking behaviors experience worsening of diabetic metabolic control, it is yet to be determined whether glycemic management in children and adolescents is negatively and independently influenced by ACEs. This study examines the relationship between ACEs in children and adolescents with type 1 diabetes (T1DM) and glycemic control, BMI and lipids. For such children, we hypothesized that hemoglobin A1c (HbA1c) is positively correlated with ACE scores. Parents of children (age 2–18 years) with T1DM completed a validated ACE questionnaire. The associations between parent and child ACE score and HbA1c, lipids and BMI z-scores were assessed using linear regression. The prevalence of any ACE was 27.9% among children and 49.0% among parents. HbA1c was significantly higher in children who had exposure to three or more ACEs (β: 0.63 (4.5 mmol/mol); p = 0.02), in those who had a parent exposed to four or more ACEs (β: 0.87 (7.2 mmol/mol); p = 0.03), in children who had exposure to household incarceration (β: 0.62 (4.4 mmol/mol); p = 0.05) and children who witnessed or had been victim of violence in the neighborhood (β: 0.71 (5.4 mmol/mol); p = 0.02). ACEs were highly prevalent among children with T1DM and had a positive association with glycemic control.
Collapse
Affiliation(s)
| | | | | | | | | | - Aida Lteif
- Correspondence: ; Tel.: +1-507-284-3300; Fax: +1-507-284-0727
| |
Collapse
|
22
|
Smith LB, Foster N, Bollepalli S, Fitterman-Harris HF, Rancourt D. An Examination of Sex Differences in a Disease-Specific Model of Disordered Eating Behaviors in Type 1 Diabetes. J Pediatr Psychol 2020; 45:91-100. [PMID: 31764987 PMCID: PMC6964220 DOI: 10.1093/jpepsy/jsz090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Preliminary evidence supports the integration of type 1 diabetes (T1D) disease-specific factors into eating disorder risk models. The current study explored whether cross-sectional associations among constructs included in the modified dual pathway model of eating disorder risk for individuals with T1D are similar across sex among adolescents and young adults with T1D. METHODS Original study participants were recruited from the T1D Exchange Clinic Network, a U.S. registry of individuals with T1D. Online surveys included measures of general eating disorder risk factors, hypothesized T1D-specific risk factors, and a T1D-specific eating disorder questionnaire. The current study is a secondary analysis with the adolescents (13-17 years; n = 307; 46.9% female) and young adults (18-25 years; n = 313; 62.6% female) from the original sample. In the absence of strong measurement invariance for all measures of interest, sex-specific path models were estimated among the adolescent and young adult cohorts. RESULTS Only two paths emerged as significant in the female, but not male, adolescent model. In the young adult cohort, all significant paths were the same across sex. CONCLUSIONS Both general and T1D-specific risk factors are associated with disordered eating behaviors in the T1D population. Patterns of associations were similar across male and female youth with T1D, suggesting that sex-specific prevention approaches to disordered eating behaviors among T1D youth may not be warranted.
Collapse
Affiliation(s)
- Laura B Smith
- Department of Pediatrics, Diabetes & Endocrinology Center, Morsani College of Medicine, University of South Florida
| | | | - Sureka Bollepalli
- Department of Pediatrics, Diabetes & Endocrinology Center, Morsani College of Medicine, University of South Florida
| | | | | |
Collapse
|
23
|
Meal timing, meal frequency, and breakfast skipping in adult individuals with type 1 diabetes - associations with glycaemic control. Sci Rep 2019; 9:20063. [PMID: 31882789 PMCID: PMC6934661 DOI: 10.1038/s41598-019-56541-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/08/2019] [Indexed: 12/26/2022] Open
Abstract
We assessed meal timing, meal frequency, and breakfast consumption habits of adult individuals with type 1 diabetes (n = 1007) taking part in the Finnish Diabetic Nephropathy Study, and studied whether they are associated with glycaemic control. Data on dietary intake and blood glucose measurements were retrieved from food records. HbA1c was measured at the study visit. In the whole sample, four peaks of energy intake emerged. Energy intake was the greatest in the evening, followed by midday. Altogether 7% of the participants reported no energy intake between 05:00 and 09:59 (breakfast skippers). While breakfast skippers reported lower number of meals, no difference was observed in the total energy intake between those eating and omitting breakfast. In a multivariable model, skipping breakfast was associated with higher mean blood glucose concentrations and lower odds of good glycaemic control. A median of 6 daily meals was reported. Adjusted for confounders, the number of meals was negatively associated with HbA1c, and the mean of the blood glucose measurements, but positively associated with the variability of these measurements. Our observations support the habit of a regular meal pattern, including consumption of breakfast and multiple smaller meals for good glycaemic control in adults with type 1 diabetes. However, an increase in the blood glucose variability may additionally be expected with an increase in the number of meals eaten.
Collapse
|
24
|
Peducci E, Mastrorilli C, Falcone S, Santoro A, Fanelli U, Iovane B, Incerti T, Scarabello C, Fainardi V, Caffarelli C, Di Mauro D, Dodi I, Tchana B, Vanelli M. Disturbed eating behavior in pre-teen and teenage girls and boys with type 1 diabetes. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 89:490-497. [PMID: 30657117 PMCID: PMC6502093 DOI: 10.23750/abm.v89i4.7738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 12/27/2022]
Abstract
AIM To investigate Disturbed Eating Behavior (DEB) and eating patterns in the context of a teenage population with T1D. METHODS DEB was investigated using Eating Disorder Examination (EDE) test by a psychologist. Questions regarding insulin dosage manipulation or omission to obtain decrease in weight were added. Specific behavioral items from the EDE were used to define DEB: Objective Binge-eating, Self-induced Vomiting for weight control; the use of Diuretics, Laxatives or Insulin Omission for weight loss. Some EDE items provided information about four composite subscales which assesse Restraint, Eating concern, Shape concern and Weight concern. RESULTS Shape and Weight concern showed significantly higher scores than those observed in the other two subscales (p=0.021). Average scores of each subscale resulted significantly higher in girls than in boys as well as in teen than in pre-teen participants. Objective binge eating (20%) and insulin dosage omission or reduction (17.6%) were the most common DEB (p<0.03). Forty-one percent of participants reported to consume three, 25% four and 34% five meals daily. A significantly lower proportion of females than males resulted to consume breakfast and mid-afternoon snacks. CONCLUSIONS Findings from this study suggest that caregivers working in pediatric diabetes units should be alert in order to discover some DEB such as medication omission and binge-eating, all indicative symptoms of dissatisfaction of the body and psychological distress in diabetes management.
Collapse
|
25
|
Moskovich AA, Dmitrieva NO, Babyak MA, Smith PJ, Honeycutt LK, Mooney J, Merwin RM. Real-time predictors and consequences of binge eating among adults with type 1 diabetes. J Eat Disord 2019; 7:7. [PMID: 30923613 PMCID: PMC6421642 DOI: 10.1186/s40337-019-0237-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/20/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Objective binge eating (OBE) is common among individuals with type 1 diabetes (T1D) and may have negative consequences for glycemic control. Recent studies have suggested that diabetes distress (i.e., emotional distress specific to diabetes and living with the burden of management) is a distinct emotional experience among individuals with diabetes. Preliminary studies have found diabetes distress is associated with eating disorder symptoms and poor glycemic control. The aim of the current study was to examine real-time emotional precursors and consequences of OBE in adults with T1D (i.e., general negative affect, specific emotional states and diabetes distress) using ecological momentary assessment methods. We also explore the impact of OBE on 2-h postprandial glycemic control relative to non-OBE eating episodes. METHODS Adults with T1D (N = 83) completed 3-days of ecological momentary assessment assessing mood and eating behavior using a telephone-based survey system. Participants were prompted to rate momentary affect, including level diabetes distress, at random intervals and reported on eating episodes. Participants also wore continuous glucose monitors allowing for ongoing assessment of glycemic control. Multi-level modeling was used to examine between- and within-person effects of momentary increases in emotions prior to eating on the likelihood of OBE and the impact of OBE on postprandial blood glucose. Generalized linear mixed models examined whether change in post-meal affect differed between OBE and non-OBE episodes. RESULTS Participants were predominately middle-aged (Mean = 42; SD = 12.43) Caucasian (87%) females (88%) reporting clinically significant eating disorder symptoms (76%). Nearly half of the sample (43%) reported OBE during the 3-day study period. The between-person effect for negative affect was significant (OR = 1.93, p < .05), indicating a 93% increased risk of OBE among individuals with higher negative affect compared to individuals with average negative affect. Between-person effects were also significant for guilt, frustration and diabetes distress (OR = 1.48-1.77, ps < .05). Analyses indicated that mean change in post-meal negative affect was significantly greater for OBE relative to non-OBE episodes (B = 0.44, p < .001). Blood glucose at 120 min postprandial was also higher for OBE than for non-OBE episodes (p = .03). CONCLUSIONS Findings indicate that individuals who tend to experience negative affect and diabetes distress before eating are at increased risk of OBE at the upcoming meal. Results also suggest that engaging in binge eating may result in greater subsequent negative affect, including diabetes distress, and lead to elevated postprandial blood glucose levels. These findings add to a growing literature suggesting diabetes distress is related to eating disordered behaviors among individuals with T1D.
Collapse
Affiliation(s)
| | | | - Michael A Babyak
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Patrick J Smith
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Lisa K Honeycutt
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Jan Mooney
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| | - Rhonda M Merwin
- 1Duke University Medical Center, DUMC Box 3842, Durham, NC 27712 USA
| |
Collapse
|
26
|
Almeda-Valdes P, Palacio Ríofrio J, Zamudio Coronado K, Rivera de la Parra D, Bermeo Cabrera J, Gómez-Pérez F, Aguilar-Salinas C, Mehta R. Factors Associated with Insulin Nonadherence in Type 1 Diabetes Mellitus Patients in Mexico. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000502903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
<b><i>Background:</i></b> Lack of adherence to insulin therapy is common among patients with type 1 diabetes. Factors associated with insulin omission in adult persons with type 1 diabetes in Latin America have not been studied in detail. <b><i>Objectives:</i></b> To investigate factors associated with insulin nonadherence including the presence of psychological disorders (disordered eating behaviors and depression) in adult patients with type 1 diabetes. <b><i>Methods:</i></b> Cross-sectional study including 104 consecutive adults (≥18 years old) attending a tertiary care center in Mexico City. Adherence to insulin therapy was measured with a specific item in a questionnaire. Sociodemographic data and factors related to insulin omission, including validated questionnaires to evaluate disordered eating behavior and depression, were collected and compared between the nonadherent and adherent groups with parametric or nonparametric statistical tests, as appropriate. <b><i>Results:</i></b> We classified 51 (49.1%) patients as nonadherent and 53 (50.9%) as adherent. Adherent subjects reported that they planned their activities around insulin application more often than the nonadherent subjects did (43.4 vs. 23.5%, <i>p</i> = 0.032). In a logistic regression model, fear of hypoglycemia (OR = 11.39) and economic reasons (OR = 6.02) were independently associated with insulin adherence. Presence of disordered eating behavior was identified in 14.4% of subjects, the majority belonging to the nonadherent group. <b><i>Conclusions:</i></b> Only 50% of the patients with type 1 diabetes were adherent. The principal factors associated with nonadherence were economic reasons and fear of hypoglycemia.
Collapse
|
27
|
Tracy EL, Berg CA, Baker AC, Mello D, Litchman ML, Wiebe DJ. Health-risk Behaviors and Type 1 Diabetes Outcomes in the Transition from Late Adolescence to Early Emerging Adulthood. CHILDRENS HEALTH CARE 2018; 48:285-300. [PMID: 31588160 PMCID: PMC6777546 DOI: 10.1080/02739615.2018.1531758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined within- and between-person associations between health-risk behaviors (smoking, drinking, insulin withholding) and type 1 diabetes (T1D) outcomes (adherence and HbA1c) during the high-risk transition from late adolescence to early emerging adulthood utilizing a 2-year longitudinal study. Beginning in the senior year of high school, participants (n = 197) with T1D completed measures of health-risk behaviors, adherence, and HbA1c annually at three time points. Health-risk behaviors were associated with poorer diabetes outcomes during the transition from late adolescence to early emerging adulthood. These results highlight the importance of monitoring health-risk behaviors regularly and intervening to reduce health-risk behaviors during this important developmental transition.
Collapse
Affiliation(s)
| | | | - Ashley C. Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | - Daniel Mello
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | | | - Deborah J. Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| |
Collapse
|
28
|
De Paoli T, Rogers PJ. Disordered eating and insulin restriction in type 1 diabetes: A systematic review and testable model. Eat Disord 2018; 26:343-360. [PMID: 29182474 DOI: 10.1080/10640266.2017.1405651] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To provide an overview of the existing literature pertaining to insulin restriction as a disordered eating behaviour in individuals with type 1 diabetes and present a novel maintenance model: The Transdiagnostic Model of Disordered Eating in Type 1 Diabetes. METHOD A systematic review was conducted of the current literature relevant to insulin restriction and/or omission in the context of disordered eating in type 1 diabetes. A new maintenance model was then developed by incorporating diabetes-specific factors into existing eating disorder models. RESULTS Type 1 diabetes may complicate the development and maintenance of disordered eating behaviour. Diabetes-specific circumstances, including disease diagnosis, insulin management, insulin restriction, and diabetes-related complications, contribute to the maintenance of disordered eating cognitions and behaviours. DISCUSSION The proposed model offers a comprehensive representation of insulin restriction as a disordered eating behaviour in type 1 diabetes. Future research should test the model to further understand the mechanisms underlying disordered eating in type 1 diabetes and inform treatments for this at-risk population.
Collapse
Affiliation(s)
- Tara De Paoli
- a Melbourne School of Psychological Sciences , The University of Melbourne , Melbourne , VIC , Australia
| | - Peter J Rogers
- b Nutrition and Behaviour Unit, School of Experimental Psychology , University of Bristol , Bristol , United Kingdom
| |
Collapse
|
29
|
Powers MA, Gal RL, Connor CG, Mangan M, Maahs DM, Clements MA, Mayer-Davis EJ. Eating patterns and food intake of persons with type 1 diabetes within the T1D exchange. Diabetes Res Clin Pract 2018; 141:217-228. [PMID: 29772288 PMCID: PMC7423164 DOI: 10.1016/j.diabres.2018.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/18/2018] [Accepted: 05/08/2018] [Indexed: 01/20/2023]
Abstract
AIMS To identify dietary intake and eating patterns of people with type 1 diabetes from childhood to later adulthood in relation to HbA1c. METHODS Trained interviewers conducted 24-hour recalls via phone utilizing a multiple pass approach and administered two nutrition questionnaires; 463 participants (or parents of participants) within the T1D Exchange clinic registry were included. Participants were 5 to 81 years with 80-101 participants in five age groups; 56% were female, and 92% were white, with a median diabetes duration of 11.1 years and a median HbA1c of 7.4% [57 mmol/mol]). RESULTS Those with type 1 diabetes consumed less calories from carbohydrates and more from fats and protein than those in the general population, based on the National Health and Nutrition Examination Survey data. Carbohydrate intake was not correlated with HbA1c levels. Increased fiber intake, more eating occasions, higher Healthy Eating Index scores, and higher nutrition knowledge scores were each associated with lower HbA1c levels. CONCLUSIONS Food intake, eating patterns and nutrition knowledge are associated with glycemic control across a registry-based cohort of adults and children with type 1 diabetes. Additionally, these data can inform the design of future studies to advance our understanding of nutritional influences on type 1 diabetes self-care and control.
Collapse
Affiliation(s)
| | - Robin L Gal
- Jaeb Center for Health Research, United States
| | | | - Meg Mangan
- University of North Carolina, REX Healthcare, United States
| | - David M Maahs
- Department of Pediatrics, Division of Endocrinology, Stanford University, United States
| | | | | |
Collapse
|