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Barsal Çetiner E, Donbaloğlu Z, İnan Yüksel A, Singin B, Aydın Behram B, Bedel A, Parlak M, Tuhan H. Disordered eating behaviors and associated factors in children and adolescents with type 1 diabetes. Arch Pediatr 2024:S0929-693X(24)00111-8. [PMID: 39214765 DOI: 10.1016/j.arcped.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/26/2024] [Accepted: 04/28/2024] [Indexed: 09/04/2024]
Abstract
OBJECT As part of their treatment, patients with type 1 diabetes mellitus (DM) have to be very careful with what they eat and with their insulin doses. Therefore, the risk of eating disorders increases in this patient group. In this study, we aimed to determine the disordered eating behaviors of patients with type 1 DM and to evaluate the sociodemographic characteristics, diabetes care behaviors, and quality-of-life scale results that these behaviors may be related to. METHOD The sociodemographic characteristics and diabetes treatment data of 191 patients aged 9-18 years with type 1 DM were analyzed. The Pediatric Quality of Life Inventory (PedsQL), the PedsQL 3.0 Diabetes Module, and the Diabetes Eating Problem Survey-Revised (DEPS-R) were applied. RESULTS The median DEPS-R score of the patients was 18 (19.00), and 44.5 % had a DEPS-R score above 20. A significant correlation was found between age, duration of diabetes, frequency of blood glucose measurement, hemoglobin A1c (HbA1c) level, body mass index standard deviation score (BMI-SDS), and DEPS-R score. There was no significant difference between girls and boys. Patients with a high DEPS-R score had low scores on the PedsQL and on the PedsQL 3.0 Diabetes Module. CONCLUSION The DEPS-R scale is a diabetes-specific, easy-to-use, and effective method for screening patients with type 1 DM for disordered eating behaviors. It can help prevent the progression of disordered eating behaviors to clinical eating disorders in patients with type 1 DM. It would be beneficial to use this scale as a routine screening, especially in clinics where access to a psychologist is not possible.
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Affiliation(s)
- Ebru Barsal Çetiner
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey
| | - Zeynep Donbaloğlu
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey
| | - Aynur İnan Yüksel
- Department of Pediatrics, Akdeniz University Hospital, Antalya, Turkey
| | - Berna Singin
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey
| | - Bilge Aydın Behram
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey
| | - Aynur Bedel
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey
| | - Hale Tuhan
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Konyaalti, Antalya, 07070, Turkey.
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Vidyasagar S, Griffin A, d'Emden H, Hendrieckx C, D'Silva N. Perceived comfort with weight, body shape and eating pattern of young adults with type 1 diabetes and associations with clinical and psychological parameters in a clinical setting. J Eat Disord 2024; 12:106. [PMID: 39080802 PMCID: PMC11289989 DOI: 10.1186/s40337-024-01059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/05/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Higher prevalence of disordered eating in young adults with type 1 diabetes (T1D) culminates in higher levels of morbidity and mortality. In addition to validated questionnaires for diabetes distress, depression/anxiety symptoms and emotional well-being, the Diabetes Psychosocial Assessment Tool (DPAT) includes three questions about comfort with weight, body shape and eating pattern (WSE), which were derived from literature and multidisciplinary team consensus. Recognising individuals with low comfort with WSE, is the first step towards identifying those who may be at risk of developing eating disorders. AIMS Observe comfort with WSE, in young adults with T1D, and its associations with demographic/clinical characteristics and psychological parameters. METHODS 276 young adults, aged 15-26, who attended routine clinical care at a Young Adult Diabetes Clinic, completed the DPAT. The WSE questions were scored on a 5-point Likert scale (1 indicating lowest comfort). Linear regression analysed differences in comfort with weight and eating pattern by demographic and psychological parameters. RESULTS 1 in 3 young adults (29%) reported low comfort with WSE (scores 1 or 2). In females, 40%, 41% and 35% had low comfort with weight, shape and eating patterns respectively, in comparison to males in whom it was 18.5%, 16% and 21.5%. Females reported lower comfort with weight and eating pattern (mean 2.9 and 3.0 respectively) than Males (mean 3.7 and 3.6 respectively), each p < 0.001. Lower comfort with weight (p < 0.001) and eating pattern (p = 0.001) was associated with higher body mass index (BMI). Young adults with low comfort with weight and eating pattern experienced elevated diabetes distress and depressive/anxiety symptoms (each p < 0.001), also when adjusted for sex and BMI. CONCLUSIONS The study has shown that low comfort with WSE is common among young adults with T1D. Adding these questions into routine care, can allow for easy and early identification of low comfort, initiation of a therapeutic dialogue and implementation of focused management strategies.
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Affiliation(s)
- Sneha Vidyasagar
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Cnr Raymond Terrace, South Brisbane, QLD, 4101, Australia.
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Christel Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, VIC, Australia
- School of Psychology, Deakin University, Geelong, Australia
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Neisha D'Silva
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Cnr Raymond Terrace, South Brisbane, QLD, 4101, Australia
- University of Queensland, Brisbane, Australia
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Harrison A, Konstantara E, Zaremba N, Brown J, Allan J, Pillay D, Hopkins D, Treasure J, Ismail K, Stadler M. A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in adult men with Type 1 diabetes mellitus. Diabet Med 2024; 41:e15287. [PMID: 38379243 DOI: 10.1111/dme.15287] [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: 09/12/2023] [Revised: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
AIMS This qualitative study aimed to develop the first cognitive behavioural (CBT) model outlining the development and maintenance of disordered eating in adult men living with Type 1 diabetes to improve on previous theoretical models of Type 1 diabetes and disordered eating and to draw comparisons to women with Type 1 diabetes and disordered eating. METHODS Twenty-seven men (n = 16 with Type 1 diabetes and disordered eating, n = 11 with Type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using thematic analysis and individual CBT formulations were developed for each participant to inform the model. RESULTS Men with Type 1 diabetes and disordered eating experience negative thoughts about food, insulin, weight/shape and diabetes itself, which cause negative emotions such as fear and vulnerability and difficulties with diabetes self care such as problems with hyper and hypoglycaemia and problems accessing structured education and technology result in men feeling more dissatisfied about their body weight/shape. CONCLUSIONS This CBT model of disordered eating in men with Type 1 diabetes can guide new interventions.
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Affiliation(s)
- Amy Harrison
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Psychology and Human Development, Institute of Psychiatry, University College London, London, UK
| | - Emmanouela Konstantara
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Natalie Zaremba
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Jennie Brown
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Diabetes Centre, King's College Hospital, London, UK
| | - Jacqueline Allan
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Divina Pillay
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - David Hopkins
- Diabetes Centre, King's College Hospital, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
- Diabetes Centre, King's College Hospital, London, UK
| | - Marietta Stadler
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Diabetes Centre, King's College Hospital, London, UK
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Zaremba N, Harrison A, Brown J, Allan J, Pillay D, Treasure J, Ayis S, Hopkins D, Ismail K, Stadler M. Protocol for the STEADY intervention for type 1 diabetes and disordered eating: Safe management of people with Type 1 diabetes and EAting Disorders studY. Diabet Med 2024; 41:e15273. [PMID: 38191796 DOI: 10.1111/dme.15273] [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: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
This paper describes the protocol to test the feasibility of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) intervention. STEADY is a novel complex intervention for people with type 1 diabetes and disordered eating (T1DE) of mild to moderate severity. The STEADY intervention integrates cognitive behavioural therapy (CBT) with diabetes education, and was developed using Experience-Based Co-Design. METHODS: The feasibility of STEADY will be tested using a randomised controlled feasibility trial. Forty adults with T1DE will be recruited and randomised into the STEADY intervention or treatment as usual control group. We will collect demographic, biomedical and psychometric data, routine glucose metrics and conduct the Structured Clinical Interview for DSM-5. Participants randomised to the STEADY intervention will receive 12 STEADY therapy sessions with a diabetes specialist nurse trained in CBT, delivered via videoconference and an optional smartphone app. The main outcome at 6 months will be the feasibility of STEADY (recruitment, dropout rates, feasibility of delivery). The secondary outcomes are biomedical (HbA1c and glucose time in range) and psychological (person-reported outcome measures in disordered eating, diabetes distress, depression and anxiety). A process evaluation will evaluate the fidelity, feasibility, acceptability and appropriateness of STEADY, and participant experiences. ETHICS AND DISSEMINATION: The protocol was approved by the East of England-Essex Research Ethics Committee (21/EE/0235). Study findings will be shared with study participants and disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Natalie Zaremba
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Amy Harrison
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
- Department of Psychology and Human Development, Institute of Psychiatry, University College London, London, UK
| | - Jennie Brown
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Diabetes Centre, King's College Hospital, London, UK
| | - Jacqueline Allan
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Divina Pillay
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Salma Ayis
- School Population Health and Environmental Sciences, King's College London, London, UK
| | - David Hopkins
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
| | - Marietta Stadler
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
- Department of Psychological Medicine, Diabetes, Psychology and Psychiatry Research Group, King's College London, London, UK
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Ramamoorthy T, Kulothungan V, Mappillairaju B. Topic modeling and social network analysis approach to explore diabetes discourse on Twitter in India. Front Artif Intell 2024; 7:1329185. [PMID: 38410423 PMCID: PMC10895681 DOI: 10.3389/frai.2024.1329185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction The utilization of social media presents a promising avenue for the prevention and management of diabetes. To effectively cater to the diabetes-related knowledge, support, and intervention needs of the community, it is imperative to attain a deeper understanding of the extent and content of discussions pertaining to this health issue. This study aims to assess and compare various topic modeling techniques to determine the most effective model for identifying the core themes in diabetes-related tweets, the sources responsible for disseminating this information, the reach of these themes, and the influential individuals within the Twitter community in India. Methods Twitter messages from India, dated between 7 November 2022 and 28 February 2023, were collected using the Twitter API. The unsupervised machine learning topic models, namely, Latent Dirichlet Allocation (LDA), non-negative matrix factorization (NMF), BERTopic, and Top2Vec, were compared, and the best-performing model was used to identify common diabetes-related topics. Influential users were identified through social network analysis. Results The NMF model outperformed the LDA model, whereas BERTopic performed better than Top2Vec. Diabetes-related conversations revolved around eight topics, namely, promotion, management, drug and personal story, consequences, risk factors and research, raising awareness and providing support, diet, and opinion and lifestyle changes. The influential nodes identified were mainly health professionals and healthcare organizations. Discussion The study identified important topics of discussion along with health professionals and healthcare organizations involved in sharing diabetes-related information with the public. Collaborations among influential healthcare organizations, health professionals, and the government can foster awareness and prevent noncommunicable diseases.
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Affiliation(s)
- Thilagavathi Ramamoorthy
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Vaitheeswaran Kulothungan
- ICMR-National Centre for Disease Informatics and Research, Bengaluru, India
- SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Bagavandas Mappillairaju
- Centre for Statistics, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
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Poos S, Faerovitch M, Pinto C, Jamalkhani N, Chaudhri F, Khan S, Lo DF, McGowan K, Martin A. The role of diabetes distress in Diabulimia. J Eat Disord 2023; 11:213. [PMID: 38041170 PMCID: PMC10691075 DOI: 10.1186/s40337-023-00924-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/31/2023] [Indexed: 12/03/2023] Open
Abstract
IMPORTANCE Diabulimia is a disordered eating behavior in which a person with type 1 diabetes withholds insulin injections to lose weight. It is thought that the psychosocial stress of managing this chronic disease, which is termed diabetes distress, may contribute to developing diabulimia. OBJECTIVE This paper explores links between diabetes distress and diabulimia and their relevance to the diagnosis and treatment of diabulimia by assessing whether people with diabulimia report measurable evidence of diabetes distress. EVIDENCE REVIEW We evaluated studies examining the qualitative experiences of people with disordered eating behaviors in the setting of type 1 diabetes for themes of diabetes distress by identifying aspects of the patients' stories that matched the criteria in the Diabetes Distress Scale. Selected studies recorded primary data, analyzed qualitative data, examined lived experiences of individuals with diabulimia, and were made available in English-language peer-reviewed journals between January 1, 2000 and August 31, 2022. Exclusion criteria included partial articles, editorials, reviews, and abstracts along with studies of patients with type 2 diabetes. FINDINGS Over forty individual participants across twelve studies were found to have aspects of their experiences that met one or more criteria from the Diabetes Distress Scale. Participants reported experiences that matched criteria items from each of the seven subscales of the Diabetes Distress Scale. Participants in the twelve studies included 185 individuals with type 1 diabetes experiencing diabulimia, including 164 females (88.6%), 20 males (10.8%), and 1 non-reported gender (0.54%). CONCLUSION We believe this discovery warrants further research probing the prevalence of diabetes distress among people with diabulimia as well as other links between the two conditions. We advocate for a diabetes distress-informed approach to diabulimia treatment and for diabetes distress screening in every patient with type 1 diabetes.
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Affiliation(s)
- Stephen Poos
- Stony Brook Southampton Hospital, 240 Meeting House Ln, Southampton, NY, USA
| | - Misha Faerovitch
- School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY, USA
| | - Celeste Pinto
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA
| | - Nima Jamalkhani
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA
| | - Fahad Chaudhri
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA
| | - Satara Khan
- Touro University, 3 Times Sq, New York, NY, USA
| | - David F Lo
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA.
| | - Kaitlin McGowan
- Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, USA
| | - Ashaki Martin
- Ocean University Medical Center, 425 Jack Martin Blvd, Brick, NJ, USA
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Kara A, Gerçek HG, Özkan Y, Çelikkol Sadıç Ç, Koca SB. Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study. J Pediatr Endocrinol Metab 2023; 36:957-965. [PMID: 37725202 DOI: 10.1515/jpem-2023-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Type 1 diabetes (T1D) causes psychological distress, negatively impacting normal childhood activities. Depression, anxiety disorders, and eating problems are commonly observed in this population. METHODS The study population consisted of 40 adolescents (22 females and 18 males) who had been diagnosed with T1D and 41 healthy adolescents (21 females and 20 males). The aim of this study was to compare adolescents with T1D to healthy controls in terms of depression, anxiety, and eating problems and subsequently examine the T1D group in relation to the risk of diabetes-specific eating disorders. Eating Attitudes Test (EAT-40), Revised Children's Anxiety and Depression Scale (RCADS), and Diabetes Eating Problem Survey - Revised (DEPS-R) scales were used to compare the case and control groups. RESULTS The case group exhibited significantly higher scores in EAT-40 total score, RCADS parent form major depressive disorder (MDD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD), total anxiety score, total scale scores, RCADS child form MDD, PD, and total scale scores compared to the control group. Individuals at high risk of diabetes-specific eating disorder within the case group demonstrated significantly higher RCADS (child and parent form) MDD scores and RCADS parent form separation anxiety (SA) and total scale scores. Binary logistic regression analysis revealed that the RCADS parent form total scale score could predict DEPS-R. CONCLUSIONS Routine screening of children and adolescents diagnosed with T1D for depression, anxiety, and eating disorder risk may facilitate early detection of possible psychopathologies, allowing for early intervention to address factors that may disrupt treatment adherence. Further longitudinal studies with larger samples are needed to investigate psychopathologies, particularly eating disorders, in children and adolescents with T1D.
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Affiliation(s)
- Aziz Kara
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Hacer Gizem Gerçek
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Yekta Özkan
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Çağla Çelikkol Sadıç
- Department of Child and Adolescent Psychiatry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Serkan Bilge Koca
- Department of Pediatric Endocrinology, University of Health Sciences, Kayseri City Hospital, Kayseri, Türkiye
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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.
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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.
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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
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Ferrey A, Ashworth G, Cabling M, Rundblad G, Ismail K. A thematic analysis of YouTube comments on a television documentary titled 'Diabulimia: The World's most dangerous eating disorder'. Diabet Med 2022; 40:e15025. [PMID: 36508358 DOI: 10.1111/dme.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
AIM Omitting insulin for fear of weight gain is a type of disordered eating (also labelled as diabulimia) common in type 1 diabetes (T1D) and is associated with a worse biomedical prognosis but is not a formally recognised condition. This research explored the public's opinion of diabulimia as a condition as presented in a television documentary. METHODS We conducted a coding reliability thematic analysis using NVivo software of the original comments to a YouTube documentary 'Diabulimia: The World's Most Dangerous Eating Disorder' between 24 September 2017 and 16 June 2020. RESULTS Of 1424 original comments, 1264 were eligible and uploaded into NVivo 12. The commenters were people with T1D, family and friends, health care professionals, and the wider public who collectively had questions, personal stories and/or opinions. Three main themes were discerned: lack of awareness of diabulimia as a condition; the importance of support; diabulimia as a psychiatric condition in the diabetes setting. CONCLUSION This analysis of social media comments found that there is a lack of awareness of diabulimia amongst patients, their families and friends, and healthcare professionals and that there were many commenters who had the experience of disordered eating with T1D. This study has reported on themes that suggest there may be an eating disorder specifically in people with T1D and that further work is needed to understand the diagnostic criteria for diabulimia in order to develop effective treatments.
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Affiliation(s)
- Amy Ferrey
- James Paget University Hospital, Great Yarmouth, United Kingdom
| | - Georgia Ashworth
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark Cabling
- School of Education, Communication & Society, King's College London, London, United Kingdom
| | | | - Khalida Ismail
- Weston Education Centre, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
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11
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Affiliation(s)
- Sze May Ng
- Paediatric department, Southport and Ormskirk NHS Trust, Ormskirk, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | | | | | - Partha Kar
- Diabetes and endocrine department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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12
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TURAN H, GÜNEŞ KAYA D, TARÇIN G, EVLİYAOĞLU SO, ERCAN O. Adölesanlarda diyabete özgü yeme bozukluğu:‘Diabulimia’ riskinin ve metabolik etkilerinin araştırılması. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1085617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Goddard MG, Oxlad M. Insulin Restriction or Omission in Type 1 Diabetes Mellitus: A Meta-synthesis of Individuals' Experiences of Diabulimia. Health Psychol Rev 2022; 17:227-246. [PMID: 34979879 DOI: 10.1080/17437199.2021.2025133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Unique to individuals with insulin-dependent diabetes mellitus (IDDM) is a disordered eating behaviour whereby insulin is deliberately restricted or omitted. Despite growing research in this area, experiential perspectives of individuals remain understudied. Therefore, the purpose of this meta-synthesis was to explore the experiences of individuals with Type 1 Diabetes Mellitus (T1DM) by identifying, analysing and synthesising existing knowledge concerning their misuse of insulin for weight control. DESIGN Meta-aggregative techniques were employed to generate synthesised findings related to individuals' understanding and experience, physical and psychological impacts, support and treatment-related needs and experiences, noted in twelve studies. RESULTS A multifaceted relationship with the unique disordered eating behaviour, beyond weight control was identified. Many individuals experienced a wide range of diabetes-related complications from insulin restriction and omission alongside increased distress, loss of control and feelings of regret, guilt, and shame later in life. Almost all individuals valued peer support from those who shared a 'diabulimic' identity; peer support appeared more conducive to recovery than support from friends, family and formal support services, which were not uniformly supportive. CONCLUSIONS This meta-synthesis revealed valuable information from individuals with diabulimia which has widespread interdisciplinary implications and may provide useful guidance concerning the prevention and treatment of this unique behaviour. The results highlight the need for empathic, collaborative care, and proactive prevention and early intervention. Furthermore, the findings highlight the value of peer support in recovery, the need for increased knowledge among family and friends, training among multidisciplinary teams and support services, and crucially the development of evidence-based treatments informed by the behaviour as a unique distinct construct.
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Affiliation(s)
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Australia
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14
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Karmegam D, Mappillairaju B. Social media analytics and reachability evaluation - #Diabetes. Diabetes Metab Syndr 2022; 16:102359. [PMID: 34920205 DOI: 10.1016/j.dsx.2021.102359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/17/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Diabetes as a lifestyle disorder could be effectively managed by creating awareness among people through social media. Understanding the content of Twitter messages will aid in strategizing health communication about diabetes to the community through Twitter. This study aimed to analyze the content, sentiment, and reachability of diabetes related tweets posted in India. METHODS Diabetes related messages from India were collected via Twitter's Application Programming Interface for April 2019. Themes and subthemes of tweet content were identified from randomly selected tweets. The tweets were coded as the source, themes, and subthemes manually. Sentiment analysis of the tweets was done by a lexicon-based approach. The reachability of tweets was assessed based on re-tweet and favorite counts. RESULTS Out of 1840 tweets, 57.28% were from organizations and 42.72% were from individuals. The largest proportion of tweet messages were informative (50.76%), followed by promotional tweets (21.52%). The largest proportion of tweets were positive (40.4%) followed by neutral (31.14%) tweets. Among the six major themes, the diabetes story had the highest reachability. CONCLUSIONS The outcome of this study would aid public health professionals in planning information dissemination and communication regarding diabetes on Twitter so that the right information reaches a wider population.
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Affiliation(s)
- Dhivya Karmegam
- School of Public Health, SRM Institute of Science and Technology, Chennai, India.
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15
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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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16
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Garrett CJ, Ismail K, Fonagy P. Understanding developmental psychopathology in Type 1 diabetes through attachment, mentalisation and diabetes distress. Clin Child Psychol Psychiatry 2021; 26:682-694. [PMID: 33624515 DOI: 10.1177/1359104521994640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article examines the combined roles of attachment mentalisation and diabetes distress in the psychological development of young people with Type 1 diabetes (T1D). We use these ideas to unify the evidence for psychological variables affecting young people and their families and suggest how diabetes distress and mentalisation might be part of the pathways for development of psychiatric diagnoses.Attachment theory's central hypothesis is that a secure relationship with a care-giver in the early life of a child is essential to normal emotional and relational development, whilst diabetes distress is a well recognised phenomena of burden experienced by both child and parent in relation to the condition.We extend the ideas of attachment, into the psychological adaptation processes for young people at the time of diagnosis of T1D with emphasis on the function of the parent/caregiver in mentalising the experience of the child. We also connect our current understanding of diabetes distress to the associated increased risk for disorders of eating and personality in T1D.Using principles learnt in other areas of psychotherapeutic practice we end by suggesting interventions that could impact mental health and diabetes outcomes using the mentalisation model.
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Affiliation(s)
- Christopher J Garrett
- Bart's Health and East London Foundation Trust.,Diabetes, Psychiatry and Psychology Research Group, King's College London, UK
| | - Khalida Ismail
- Diabetes, Psychiatry and Psychology Research Group, King's College London, UK
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, UK
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17
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Harrison A, Zaremba N, Brown J, Allan J, Konstantara E, Hopkins D, Treasure J, Ismail K, Stadler M. A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus. Diabet Med 2021; 38:e14578. [PMID: 33797072 DOI: 10.1111/dme.14578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 01/31/2023]
Abstract
AIMS This qualitative study aimed to develop the first cognitive behavioural therapy model outlining the development and maintenance of disordered eating in type 1 diabetes and report on recovery strategies and resilience factors to improve previous theoretical models of type 1 diabetes and disordered eating. METHODS Twenty-three women (n = 9 with type 1 diabetes and disordered eating, n = 5 with type 1 diabetes recovering from disordered eating, and n = 9 with type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using grounded theory and individual cognitive-behavioural formulations were developed for each participant to inform the development/maintenance and resilience models. RESULTS The development/maintenance model summarises commonly experienced vicious cycles of thoughts, feelings and behaviours in type 1 diabetes and disordered eating. The resilience model summarises strategies and knowledge acquired by those with type 1 diabetes in recovery from disordered eating and individuals with type 1 diabetes who did not develop disordered eating. Early adverse life events, past psychiatric history, perfectionist personality traits, difficult experiences around type 1 diabetes diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms/complications, unhelpful interpersonal reactions and inadequate healthcare, vicious cycles of thoughts, feelings and behaviours develop. 'Good enough' psychological adaptation to type 1 diabetes, integrating type 1 diabetes into one's identity, self care and compassion around eating, weight and shape were key protective/post-traumatic resilience factors. CONCLUSIONS This first cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experience will inform an intervention for type 1 diabetes and disordered eating.
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Affiliation(s)
- Amy Harrison
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- Department of Psychology and Human Development, University College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Natalie Zaremba
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | - Jennie Brown
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Jacqueline Allan
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | | | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Weston Education Centre, King's College London, London, UK
| | - Marietta Stadler
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- Department of Psychological Medicine, Weston Education Centre, King's College London, London, UK
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18
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Rama Chandran S, Zaremba N, Harrison A, Choudhary P, Cheah Y, Allan J, Debong F, Reid F, Treasure J, Hopkins D, Ismail K, Stadler M. Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self-care behaviour and emotion. Diabet Med 2021; 38:e14446. [PMID: 33141942 DOI: 10.1111/dme.14446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self-care behaviour and emotional state of women with type 1 diabetes and disordered eating. RESEARCH DESIGN AND METHODS In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case-control study. We used a mixed-methods approach with a 7-day blinded continuous glucose monitoring and real-time record of non-prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann-Whitney U test or Fisher's exact test. We conducted thematic analyses of free-text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags. RESULTS People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9 mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p = 0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7 mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p = 0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15 mmol/L). CONCLUSIONS Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.
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Affiliation(s)
- Suresh Rama Chandran
- Department of Diabetes, King's College Hospital, London, UK
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Natalie Zaremba
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
| | - Amy Harrison
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pratik Choudhary
- Department of Diabetes, King's College Hospital, London, UK
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
| | - Yee Cheah
- Department of Diabetes, King's College Hospital, London, UK
| | - Jacqueline Allan
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
| | | | - Fiona Reid
- Faculty of Life Sciences and Medicine, Population Health, King's College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marietta Stadler
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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19
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Ribeiro LB, Pieper CM, Frederico GA, Gamba MA, Rosa ADS. A relação entre a mulher com diabetes e o seu corpo: o risco da diabulimia. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Resumo Objetivo compreender a relação que as mulheres com diabulimia têm com o corpo. Método pesquisa qualitativa, desenvolvida com o Método da História Oral Temática, com quatro mulheres entre 18 e 30 anos que autorreferiram diabulimia. Resultados a relação das mulheres com o seu corpo foi pautada pela pressão social de magreza feminina que distorce a autoimagem, gera insatisfação com o corpo e a diminuição da autoestima. A perda de peso é proporcionalmente associada ao aumento da aceitação social e justifica a utilização de métodos deletérios à saúde como a diminuição da dose ou a suspensão do uso de insulina. As narradoras demonstraram conhecer os riscos, mas admitiram repeti-la em determinados contextos. Considerações finais e implicações para a prática o desejo que as mulheres com Diabetes Mellitus têm de perder peso precisa ser incorporado às estratégias de cuidado com a atenção dos profissionais da saúde à subjetividade, atuando para reconhecer e prevenir os transtornos alimentares em mulheres com diabetes e minimizar a adoção de ações prejudiciais à saúde.
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Affiliation(s)
| | - Claudia Maurício Pieper
- Pontifícia Universidade Católica do Rio de Janeiro, Brasil; Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Brasil
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20
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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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21
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Zaremba N, Watson A, Kan C, Broadley M, Partridge H, Figuereido C, Hopkins D, Treasure J, Ismail K, Harrison A, Stadler M. Multidisciplinary healthcare teams' challenges and strategies in supporting people with type 1 diabetes to recover from disordered eating. Diabet Med 2020; 37:1992-2000. [PMID: 31833586 DOI: 10.1111/dme.14207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
AIM To examine the challenges healthcare teams face when treating people with type 1 diabetes and disordered eating and the strategies these teams have developed to facilitate effective treatment. METHODS Four semi-structured focus groups were conducted including two tertiary diabetes specialist teams and three tertiary eating disorders specialist teams between July and December 2018. Thematic analysis of the transcripts followed a six-phase process. RESULTS Twenty-nine experienced healthcare professionals (16 diabetes and 13 eating disorder specialists, 16±12 years' professional experience) were interviewed. The challenges identified in treating people with type 1 diabetes and disordered eating included subthemes the 'challenges specific to the healthcare professional' (feeling not competent enough and perceived emotional burden), 'challenges pertaining to patient factors' (e.g. difficulties with engaging in therapy) and 'challenges created by the healthcare system' (time pressure and staff shortage). Healthcare professionals expressed the need for a consensus on diagnosis and the definition of disordered eating in type 1 diabetes, as well as the need for training and educational resources specific to type 1 diabetes and disordered eating. Healthcare professionals gave practical examples of strategies of communication for better patient engagement and felt that multidisciplinary working in joint clinics with the other specialty were facilitators for recovery from disordered eating. CONCLUSIONS Healthcare professionals require multidisciplinary team support when treating people with type 1 diabetes and to improve their own competencies. The development of effective screening and assessment tools, educational resources and training for healthcare professionals, and developing multidisciplinary treatment pathways will be key to improving outcomes for their service users with type 1 diabetes and disordered eating.
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Affiliation(s)
- N Zaremba
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | - A Watson
- Division of Medicine, University College London, London, UK
| | - C Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - H Partridge
- Diabetes Centre, Royal Bournemouth and Christchurch Hospital, Bournemouth, UK
| | - C Figuereido
- Dorset Eating Disorders Service, Royal Bournemouth and Christchurch Hospital, Bournemouth, UK
| | - D Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - J Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Ismail
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, King's College London, London, UK
| | - A Harrison
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- University College London, Institute of Education, London, UK
| | - M Stadler
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, King's College London, London, UK
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22
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Partridge H, Figueiredo C, Rouse L, Cross C, Pinder C, Ryder J, Bennett M, Stacey N. Type 1 diabetes and disordered eating (
T1DE
): the
ComPASSION
Project – Wessex. PRACTICAL DIABETES 2020. [DOI: 10.1002/pdi.2286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Helen Partridge
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – Bournemouth Diabetes and Endocrine Centre Bournemouth UK
| | - Carla Figueiredo
- Dorset HealthCare University NHS Foundation Trust – Eating Disorders Service Poole UK
| | - Lindsey Rouse
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – Bournemouth Diabetes and Endocrine Centre Bournemouth UK
| | - Caroline Cross
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – Bournemouth Diabetes and Endocrine Centre Bournemouth UK
- Dorset HealthCare University NHS Foundation Trust – Eating Disorders Service Poole UK
| | - Claire Pinder
- Dorset HealthCare University NHS Foundation Trust – Eating Disorders Service Poole UK
| | - Jacqueline Ryder
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – Bournemouth Diabetes and Endocrine Centre Bournemouth UK
| | - Michelle Bennett
- Dorset HealthCare University NHS Foundation Trust – Eating Disorders Service Poole UK
| | - Nicola Stacey
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – Bournemouth Diabetes and Endocrine Centre Bournemouth UK
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23
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Johansen CB, Pouwer F, Beck‐Nielsen H, Rothmann MJ. Positive facilitators of diabetes management in emerging adults with type 1 diabetes-A qualitative analysis of blogs. Endocrinol Diabetes Metab 2020; 3:e00161. [PMID: 32704575 PMCID: PMC7375054 DOI: 10.1002/edm2.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/16/2020] [Accepted: 05/09/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Emerging adults (18-30 years) with type 1 diabetes must manage a demanding chronic illness as well as navigate a life phase full of instability and transitions. Clinical care for this age group remains a challenge. An improved understanding of psychological facilitators of diabetes management may contribute to optimized clinical care to this age group. AIM To explore which individual strategies facilitated emerging adults' diabetes management and what kind of support they regard helpful from peers, family and healthcare providers. METHODS Qualitative analysis of web blogs. We identified personal blogs by emerging adults with type 1 diabetes through a search at the websites for diabetes associations in Denmark, UK and the USA, a snowball search at identified blogs and an internet search (Google). Blog posts from approximately the last year were analysed with thematic analysis as described by Braun and Clarke. RESULTS We included 16 blogs from UK, the USA, Australia and Denmark, focusing on blog entries from 2017 to 2018. Several psychological facilitators of management of type 1 diabetes were identified. Positive individual strategies involved: developing a balanced approach to blood glucoses, sharing diabetes with peers and making space for emotional reactions. Supportive involvement from peers, family and health care providers included: normalization, emotional backup and a nonjudgmental attitude. CONCLUSION Diabetes management in emerging adulthood can be facilitated by several individual strategies as well as by supportive involvement from peers, family and health care providers. It is worthwhile to further investigate how individual strategies as well as supportive involvement can be promoted in diabetes care.
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Affiliation(s)
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | | | - Mette Juel Rothmann
- Steno Diabetes Center OdenseOdense University HospitalOdenseDenmark
- Department of EndocrinologyOdense University HospitalOdenseDenmark
- Centre for Innovative Medical TechnologyOdense University HospitalUniversity of Southern DenmarkOdenseDenmark
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Abstract
Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.
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Affiliation(s)
- Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tiago Antunes Duarte
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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25
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Broadley MM, Zaremba N, Andrew B, Ismail K, Treasure J, White MJ, Stadler M. 25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt? Diabet Med 2020; 37:401-408. [PMID: 31797439 DOI: 10.1111/dme.14197] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Disordered eating is a serious and under-recognized problem in people with diabetes. This narrative review summarizes the research contributions made by psychological science over the past 25 years to the study of disordered eating in people with type 1 or type 2 diabetes, and identifies gaps and future directions relevant to both healthcare professionals and researchers. Key focus areas of psychological research investigating disordered eating in people with diabetes have been: (1) defining and classifying types of disordered eating; (2) identifying demographic, diabetes-specific and psychosocial correlates of disordered eating, and developing theoretical models of disordered eating in people with type 1 diabetes; (3) identifying the physical and psychosocial consequences of disordered eating; and (4) developing screening measures to identify disordered eating in people with type 1 diabetes. Psychological science has made significant contributions over the past 25 years to our understanding of the nature of this problem and the multiple factors which may interrelate with disordered eating in people with diabetes. Key areas for further attention include: (1) a better definition of disordered eating subtypes in people with type 1 diabetes; (2) characterizing disordered eating in people with type 2 diabetes; and (3) developing multidisciplinary, evidence-based prevention and treatment interventions for comorbid disordered eating and diabetes.
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MESH Headings
- Behavioral Research/history
- Behavioral Research/methods
- Behavioral Research/trends
- Biomedical Research/history
- Biomedical Research/methods
- Biomedical Research/trends
- Diabetes Complications/epidemiology
- Diabetes Complications/etiology
- Diabetes Complications/psychology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/psychology
- Feeding and Eating Disorders/complications
- Feeding and Eating Disorders/epidemiology
- Feeding and Eating Disorders/psychology
- History, 20th Century
- History, 21st Century
- Humans
- Psychology/history
- Psychology/methods
- Psychology/trends
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Affiliation(s)
- M M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - N Zaremba
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | - B Andrew
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - K Ismail
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, London, UK
| | - J Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M J White
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - M Stadler
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
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26
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Oser TK, Oser SM, Parascando JA, Hessler-Jones D, Sciamanna CN, Sparling K, Nease D, Litchman ML. Social Media in the Diabetes Community: a Novel Way to Assess Psychosocial Needs in People with Diabetes and Their Caregivers. Curr Diab Rep 2020; 20:10. [PMID: 32080765 DOI: 10.1007/s11892-020-1294-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Diabetes is a chronic disease that, regardless of type, requires intensive, ongoing self-management. As a result, people with diabetes (PWD) often have complex environmental, social, behavioral, and informational needs, many of which are unmet in healthcare settings and systems. To help meet these needs, many PWD interact with diabetes online communities (DOCs), including platforms such as Facebook, Twitter, and blogs, to share real-life support, problems, and concerns with other PWD, offering a rich source of data on patient-reported outcomes. This article reviews recent psychosocial needs and outcomes identified by studies of DOCs and/or their users. RECENT FINDINGS Participation in DOCs appears driven by a need for psychosocial support, unmet by providers and the healthcare system, as well as a sense of duty to provide it to others. The most common activities observed in DOCs are giving and receiving various types of support: psychosocial, technical, informational, and self-management. General and specific challenges (e.g., continuous glucose monitoring) as well as frustrations and worries associated with those challenges are commonly expressed, leading to reciprocal sharing, support, and encouragement, in a judgment-free manner, from other PWD. This leads users to feel more understood, empowered, validated, less alone, and more supported. Negative findings were reported very rarely and focused more on how other participants used social media rather than on the exchange of misplaced or dangerous information or advice. Diabetes online communities have grown from unmet needs for problem-solving and psychosocial support for living with a complex condition and from the availability of a new communications medium (i.e., social media). This has enabled communities of peers to both seek and receive support for living with diabetes, providing an important supplement to what is provided in healthcare settings and offering valuable information about what is most important to PWD and their families, with the potential to improve psychosocial care.
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Affiliation(s)
- Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop F496, Aurora, CO, 80045, USA.
| | - Sean M Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop F496, Aurora, CO, 80045, USA
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Danielle Hessler-Jones
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christopher N Sciamanna
- Departments of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Kerri Sparling
- SixUntilMe.com and KerriSparling.com, Narragansett, RI, USA
| | - Donald Nease
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop F496, Aurora, CO, 80045, USA
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27
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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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28
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Eating disorders in adolescents with chronic gastrointestinal and endocrine diseases. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:181-189. [DOI: 10.1016/s2352-4642(18)30386-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 12/19/2022]
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