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Atik-Altınok Y, Eliuz-Tipici B, İdiz C, Özgür S, Ok AM, Karşıdağ K. Psychometric properties and factor structure of the diabetes eatıng problem survey- revised (DEPS-R) among adults with type 1 diabetes mellitus. Eat Weight Disord 2023; 28:71. [PMID: 37665472 PMCID: PMC10477092 DOI: 10.1007/s40519-023-01602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/25/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Although many studies on the Diabetes Eating Problem Survey-Revised (DEPS-R) in adolescents with type 1 diabetes mellitus (T1D), the number of studies validating this questionnaire in adults with T1D is limited. Therefore, this study aimed to examine the factor structure of the Turkish version of the DEPS-R in adults with T1D and internal consistency and construct validity. METHODS A total of 100 patients with T1D, ages 18-50 years, completed the DEPS-R and EDE-Q. In addition to tests of validity, confirmatory factor analysis was conducted to investigate the factor structure of the 6-item Turkish version of DEPS-R. RESULTS The Cronbach's alpha coefficient of the DEPS-R Turkish version was 0.77, suggesting good internal consistency. The median (IQ) DEPS-R score was 15.0 (13.0) among all participants. DEPS-R score was significantly correlated with BMI (r = 0.210; p < 0.05) and EDE-Q (r = 0.586; p < 0.01). There was no correlation between the HbA1c values of participants and neither EDE-Q nor DEPS-R scores. The confirmatory factor analysis results show that the three-factor model was a good fit. CONCLUSION A short, self-administered diabetes-specific screening tool for disordered eating behavior is recommended be used routinely in the clinical care of adults with T1D, and Turkish version of DEPS-R has acceptable internal consistency and construct validity in adults with T1D. LEVEL OF EVIDENCE Level V, descriptive study. CLINICALTRIALS gov registration number NCT05346679/ 21.04.2022 (retrospectively registered).
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Affiliation(s)
- Yasemin Atik-Altınok
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Ege University, 35100, Bornova, İzmir, Turkey.
| | - Beyza Eliuz-Tipici
- Division of Pediatric Endocrinology, Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cemile İdiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Su Özgür
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ayşe Merve Ok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kubilay Karşıdağ
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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2
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Goddard G, Oxlad M, Turnbull D. The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review. J Diabetes Metab Disord 2023; 22:13-34. [PMID: 37255778 PMCID: PMC10225459 DOI: 10.1007/s40200-022-01151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
Background Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males' misuse of insulin for weight and/or shape control. Methods A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021. Results A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies). Conclusion Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01151-8.
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Affiliation(s)
- Georgia Goddard
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
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3
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Oldham-Cooper R, Semple C, Wilkinson LL. Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes. Clin Child Psychol Psychiatry 2021; 26:669-681. [PMID: 33601940 DOI: 10.1177/1359104520986215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach).
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
| | - Laura L Wilkinson
- Department of Psychology, College of Human & Health Sciences, Swansea University, Singleton Park, UK
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Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems. J Clin Psychol Med Settings 2021; 27:727-745. [PMID: 31587133 DOI: 10.1007/s10880-019-09665-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ2 = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.
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Troncone A, Cascella C, Chianese A, Zanfardino A, Confetto S, Piscopo A, Iafusco D. Parental assessment of disordered eating behaviors in their children with type 1 diabetes: A controlled study. J Psychosom Res 2019; 119:20-25. [PMID: 30947813 DOI: 10.1016/j.jpsychores.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this research is to examine the presence of disordered eating behaviors (DEBs) in youths with type 1 diabetes (T1D) according to their parents' evaluations. The roles of demographic and diabetes-related variables were also analyzed. METHODS In 54 patients with T1D (aged 10.07-15.08) and in 54 age- and gender-matched healthy controls, DEBs were assessed using a parent-report standardized measure. BMI was calculated from height and weight. Glycemic control was assessed based on the most recent glycosylated hemoglobin value (HbA1c). The association of demographic and clinical factors with DEBs was evaluated through correlation and linear regression analyses. RESULTS DEBs were observed more frequently in participants with T1D (33.3%) than in controls (11%) (χ2 = 6.501, p = .04). The clinical sample obtained a higher score than controls in PEBEQ total score (t(106) = 2.464, p = .01), as well as in the Exaggerated interest in food (t(106) = 2.723, p = .008) and Rejection/disinterest in food subscales (t(106) = 2.216, p = .01). No gender differences were observed. In participants with T1D, but not in controls, PEBEQ total score was positively correlated with age (r = 0.203, p = .04), HbA1c (r = 0.335, p = .01), and zBMI (r = 0.298, p = .002); HbA1c (standardized beta =0.284, p = .04) was found to uniquely predict the PEBEQ total score. CONCLUSION Parents' evaluations may contribute to prompt detection of DEBs, which is crucial in developing appropriate strategies for timely intervention, especially during adolescence.
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Conviser JH, Fisher SD, McColley SA. Are children with chronic illnesses requiring dietary therapy at risk for disordered eating or eating disorders? A systematic review. Int J Eat Disord 2018; 51:187-213. [PMID: 29469935 DOI: 10.1002/eat.22831] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pediatric chronic illnesses (CI) can affect a child's mental health. Chronic illnesses with treatment regimens that specify a therapeutic diet may place the child at increased risk for disordered eating and specific eating disorders (ED). The aim of this review is to examine the relation between diet-treated CI and disordered eating and to determine the order of onset to infer directionality. Diet-treated CI is hypothesized to precede and to be associated with disordered eating. METHOD A comprehensive search of empirical articles that examine the relation between diet-treated CI (diabetes, cystic fibrosis, celiac disease, gastrointestinal disorders, and inflammatory bowel diseases) and disordered eating was conducted in Medline and PsycINFO using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A table of the sample's characteristics, ED measures, major pertinent findings, and the onset of CI in relation to ED were provided. RESULTS Diet-treated CI was associated with disordered eating and ED. Diet-treated CI had onset prior to disordered eating in most studies, except for inflammatory bowel diseases. Disordered eating and unhealthy weight management practices put children at risk for poor medical outcomes. DISCUSSION Interventions for diet-treated CI require a focus on diet and weight, but may increase the risk for disordered eating. Future research is needed to elucidate the mechanisms that transform standard treatment practices into pathological eating, including characteristics and behaviors of the child, parents/care providers, family, and treatment providers.
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Affiliation(s)
- Jenny H Conviser
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario St, Chicago, Illinois, 60611
| | - Sheehan D Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario St, Chicago, Illinois, 60611
| | - Susanna A McColley
- Department of Pediatrics, Division of Pulmonary Medicine, Northwestern University Feinberg School of Medicine, 420 E. Superior Street, Chicago, Illinois, 60611
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Keane S, Clarke M, Murphy M, McGrath D, Smith D, Farrelly N, MacHale S. Disordered eating behaviour in young adults with type 1 diabetes mellitus. J Eat Disord 2018; 6:9. [PMID: 29744106 PMCID: PMC5930421 DOI: 10.1186/s40337-018-0194-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/05/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The combination of eating disorders and diabetes is associated with increased risk of morbidity and mortality. The aim of this study is to compare the prevalence of disordered eating behaviour (DEB) in young adults with type 1 diabetes mellitus to a sample of non-diabetic controls, and to examine the relationship of DEB to glycaemic control. METHODS The Eating Disorder Examination Questionnaire (EDE-Q) was administered to 51 individuals aged 18-30 years attending an outpatient diabetic clinic in a large university teaching hospital. Glycaemic control was assessed by the glycosylated haemoglobin (HbA1c). The control group comprised a consecutive sample of 236 male and female students aged 18-30 years attending a university primary health care service. RESULTS The mean global EDE-Q score for the diabetes group was 0.82 ± 1.1 (mean ± SD) and the mean for the control group was 1.4 ± 1.3 (mean ± SD). The diabetes group was significantly more likely to have a lower global EDE-Q score compared to the control group. There was no association between the global EDE-Q score of the diabetes group and HbA1c level. CONCLUSIONS We did not find increased levels of disordered eating behavior (DEB) in young adults with type 1 diabetes mellitus compared to a non-diabetic control sample.
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Affiliation(s)
- S Keane
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M Clarke
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M Murphy
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - D McGrath
- 2Trinity College Health Service, Dublin, Ireland
| | - D Smith
- 3Department of Endocrinology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - N Farrelly
- 2Trinity College Health Service, Dublin, Ireland
| | - S MacHale
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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8
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Atik Altınok Y, Özgür S, Meseri R, Özen S, Darcan Ş, Gökşen D. Reliability and Validity of the Diabetes Eating Problem Survey in Turkish Children and Adolescents with Type 1 Diabetes Mellitus. J Clin Res Pediatr Endocrinol 2017; 9:323-328. [PMID: 28270369 PMCID: PMC5785638 DOI: 10.4274/jcrpe.4219] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to show the reliability and validity of a Turkish version of Diabetes Eating Problem Survey-Revised (DEPS-R) in children and adolescents with type 1 diabetes mellitus. METHODS A total of 200 children and adolescents with type 1 diabetes, ages 9-18 years, completed the DEPS-R Turkish version. In addition to tests of validity, confirmatory factor analysis was conducted to investigate the factor structure of the 16-item Turkish version of DEPS-R. RESULTS The Turkish version of DEPS-R demonstrated satisfactory Cronbach's ∝ (0.847) and was significantly correlated with age (r=0.194; p<0.01), hemoglobin A1c levels (r=0.303; p<0.01), and body mass index-standard deviation score (r=0.412; p<0.01) indicating criterion validity. Median DEPS-R scores of Turkish version for the total samples, females, and males were 11.0, 11.5, and 10.5, respectively. CONCLUSION Disturbed eating behaviors and insulin restriction were associated with poor metabolic control. A short, self-administered diabetes-specific screening tool for disordered eating behavior can be used routinely in the clinical care of adolescents with type 1 diabetes. The Turkish version of DEPS-R is a valid screening tool for disordered eating behaviors in type 1 diabetes and it is potentially important to early detect disordered eating behaviors.
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Affiliation(s)
- Yasemin Atik Altınok
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 390 14 41 E-mail:
| | - Suriye Özgür
- Ege University Faculty of Medicine, Department of Biostatistics and Medical Informatics, İzmir, Turkey
| | - Reci Meseri
- Ege University Faculty of Health Sciences, Department of Nutrition and Dietetics, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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9
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Araia E, Hendrieckx C, Skinner T, Pouwer F, Speight J, King RM. Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth-Australia. Int J Eat Disord 2017; 50:1183-1193. [PMID: 28856699 DOI: 10.1002/eat.22746] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine gender differences in disordered eating behaviors (DEB) and body dissatisfaction in adolescents with type 1 diabetes. While evidence shows that female youth with type 1 diabetes are more prone to DEB compared to their peers without diabetes, little is known about male adolescents. METHOD In a national online survey, adolescents (13-19 years) with type 1 diabetes for ≥1 year completed the Diabetes Eating Problem Survey-Revised (DEPS-R), and the Body Mass Index Silhouette Matching Test (BMI-SMT) and items on binge eating and insulin omission. RESULTS About 477 adolescents (mean age 16 years; 62% females) completed the DEPS-R and 431 the BMI-SMT. The DEPS-R total score was higher for females than males, with scores for females increasing with age. BMI, HbA1c , insulin omission, and binge-eating frequency were associated moderately with DEPS-R for both genders. On the BMI-SMT, 88% of females wanted to be thinner. Of the males, 76% reported body dissatisfaction; however, only 43% expressed a desire for thinness with the remainder desiring a larger body size. DEPS-R was positively associated with the discrepancy between perceived actual and ideal body size for both genders. DISCUSSION A large proportion of adolescents with type 1 diabetes, particularly females reported engaging in DEB. Similarly, high rates of body dissatisfaction were reported, though ideal body shape preferences differed by gender. Given the high levels of self-reported DEB and gender-based patterns of body dissatisfaction, future research needs to examine the effectiveness of routine screening of DEB and consider implementation of stepped care approaches.
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Affiliation(s)
- Emanuala Araia
- School of Psychology, Deakin University, Geelong, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Melbourne, Diabetes Victoria, Australia
| | - Timothy Skinner
- School of Psychology and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Frans Pouwer
- Department of Psychology, South Danish University, Odense, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Melbourne, Diabetes Victoria, Australia.,AHP Research, Hornchurch, United Kingdom
| | - Ross M King
- School of Psychology, Deakin University, Geelong, Australia
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Toni G, Berioli MG, Cerquiglini L, Ceccarini G, Grohmann U, Principi N, Esposito S. Eating Disorders and Disordered Eating Symptoms in Adolescents with Type 1 Diabetes. Nutrients 2017; 9:E906. [PMID: 28825608 PMCID: PMC5579699 DOI: 10.3390/nu9080906] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/15/2022] Open
Abstract
Eating problems in adolescents with type 1 diabetes (T1D) can be divided into two groups. The first includes the diagnosed eating disorders (EDs), i.e., diseases specifically identified by defined signs and symptoms for which a degree of severity has been established, such as anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, and rumination. The second is the group of disordered eating symptoms (DES), which include behaviors such as dieting for weight loss, binge eating, self-induced vomiting, excessive exercise, and laxative or diuretic use; these behaviors cannot be categorized as complete diseases, and, although apparently mild, they must be closely evaluated because they can evolve into true EDs. In this review, present knowledge about the clinical relevance of EDs and DES and the possible preventive and therapeutic measures used to reduce their impact on the course of T1D will be discussed. As adolescents with diabetes are at higher risk of eating disturbances and consequently for higher rates of disease complications, care providers should pay attention to clinical warning signs that raise suspicion of disturbed eating to refer these patients early to an expert in nutrition and mental health disorders. To ensure the best care for adolescents with T1D, diabetes teams should be multidisciplinary and include a pediatric diabetologist, a skilled nurse, a dietician, and a psychologist.
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Affiliation(s)
- Giada Toni
- Pediatric Clinic, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
| | - Maria Giulia Berioli
- Pediatric Clinic, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
| | - Laura Cerquiglini
- Pediatric Clinic, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
| | - Giulia Ceccarini
- Pediatric Clinic, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
| | - Ursula Grohmann
- Department of Experimental Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
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Särnblad S, Magnuson A, Ekelund U, Åman J. Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual-energy X-ray absorptiometry. Acta Paediatr 2016; 105:1211-5. [PMID: 26873351 PMCID: PMC5031196 DOI: 10.1111/apa.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 02/10/2016] [Indexed: 01/20/2023]
Abstract
Aim Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual‐energy X‐ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age‐matched controls. Methods We included 49 healthy girls and 44 girls with diabetes aged 12–19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX‐L scanner. The agreement between the methods was assessed using an Bland–Altman plot. Results The skinfold measurements were significantly higher in girls with diabetes (p = 0.003) despite a nonsignificant difference in total %BF (p = 0.1). A significant association between bias and %BF was found for all tested equations in the Bland–Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p = 0.039) between the girls with diabetes and the healthy controls. Conclusion The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criterion. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.
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Affiliation(s)
- S Särnblad
- Faculty of Medical Sciences School of Medicine Örebro University Örebro Sweden
| | - A Magnuson
- Faculty of Medical Sciences Clinical Epidemiology and Biostatistics Örebro University Örebro Sweden
| | - U Ekelund
- Department of Sport Medicine Norwegian School of Sport Sciences Oslo Norway
- Medical Research Council Epidemiology Unit Cambridge UK
| | - J Åman
- Faculty of Medical Sciences School of Medicine Örebro University Örebro Sweden
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12
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Wisting L, Bang L, Natvig H, Skrivarhaug T, Dahl-Jørgensen K, Lask B, Rø Ø. Metabolic Control and Illness Perceptions in Adolescents with Type 1 Diabetes. J Diabetes Res 2016; 2016:3486094. [PMID: 26682231 PMCID: PMC4670664 DOI: 10.1155/2016/3486094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/30/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Disturbed eating behavior and psychosocial variables have been found to influence metabolic control, but little is known about how these variables interact or how they influence metabolic control, separately and combined. OBJECTIVE To explore associations between metabolic control (measured by HbA1c) and eating disorder psychopathology, coping strategies, illness perceptions, and insulin beliefs in adolescents with type 1 diabetes. METHODS A total of 105 patients (41.9% males) with type 1 diabetes (12-20 years) were interviewed with the Child Eating Disorder Examination. In addition, self-report psychosocial questionnaires were completed. Clinical data, including HbA1c, was obtained from the Norwegian Childhood Diabetes Registry. RESULTS Significant gender differences were demonstrated. Among females, HbA1c correlated significantly with eating restriction (.29, p < .05), the illness perception dimensions consequences, personal control, coherence, and concern (ranging from .33 to .48), and the coping strategy ventilating negative feelings (-.26, p < .05). Illness perception personal control contributed significantly to HbA1c in a regression model, explaining 23% of the variance among females (β .48, p < .001). None of the variables were significantly associated with HbA1c among males. CONCLUSIONS Illness perceptions appear to be important contributors to metabolic control in females, but not males, with type 1 diabetes.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- *Line Wisting:
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Henrik Natvig
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Torild Skrivarhaug
- The Norwegian Childhood Diabetes Registry, Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Rhodes Farm Clinic, The Ridgeway, Barnet, London NW7 1RH, UK
- Gt. Ormond St. Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
- Department of Psychology, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039, Blindern, 0315 Oslo, Norway
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Wilson CE, Smith EL, Coker SE, Hobbis IC, Acerini CL. Testing an integrated model of eating disorders in paediatric type 1 diabetes mellitus. Pediatr Diabetes 2015; 16:521-8. [PMID: 25229776 DOI: 10.1111/pedi.12202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/11/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Eating disorders in young people with type 1 diabetes mellitus confer additional health risks beyond those conferred by the disease itself. Risk factors for developing eating disorders are poorly understood. OBJECTIVE The current study aimed to examine risk factors for eating disturbance in young people with type 1 diabetes mellitus. Both diabetes specific risk factors, such as body mass index (BMI), glycaemic control and diabetes-related conflict, and also more general risk factors such as dysfunctional perfectionism and low self-esteem were assessed. METHODS Fifty young people aged 14-16 and their primary caregiver were asked to complete interviews and questionnaires about their eating attitudes and behaviours, dysfunctional perfectionism, self-esteem, family conflict, and general mental health symptoms. Recent weight and height and glycaemic control were extracted from the medical file. RESULTS Different factors distinguished those young people who displayed eating disorder attitudes from those who did not (higher BMI-z, poorer glycaemic control, and lower self-esteem) and those young people who displayed eating disorder behaviour from those who did not (lower self-esteem and higher diabetes-related family conflict). CONCLUSIONS The results of the current study suggest that there might be different factors associated with eating disorders (ED) attitudes and ED behaviours, but that food/eating-related factors, family factors, and intra-personal factors are all important. Furthermore there are some gender differences in the presence of ED attitudes and behaviours and preliminary evidence that higher body mass indexes (BMIs) impact on girls more than they do on boys.
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Affiliation(s)
- Charlotte E Wilson
- School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, Dublin, Ireland
| | - Emma L Smith
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Sian E Coker
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Imogen Ca Hobbis
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge Level 8/Box 116 Addenbrooke's Hospital Cambridge, Cambridge CB2 0QQ, UK
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Kaminsky LA, Dewey D. Psychological correlates of eating disorder symptoms and body image in adolescents with type 1 diabetes. Can J Diabetes 2015; 37:408-14. [PMID: 24321722 DOI: 10.1016/j.jcjd.2013.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine eating disorder symptoms and body image in adolescents with type 1 diabetes and to investigate the associations among social support, self-esteem, health locus of control, eating disorder symptoms and body image. METHODS Forty-six adolescents with type 1 diabetes and 27 healthy comparison adolescents completed questionnaires. RESULTS No significant differences were identified in eating disorder symptoms and body image between adolescents with type 1 diabetes and healthy comparison adolescents. Regression analyses were completed with the full sample of adolescents with type 1 diabetes and healthy comparison adolescents. Higher levels of social support and being male were associated with a more positive body image, less body dissatisfaction and a lower drive for thinness. A belief by the adolescents that parents or healthcare providers (i.e. external powerful others locus of control) were in control of their health was associated with a more positive body image and less body dissatisfaction. Higher self-esteem was associated with a greater drive for thinness and a higher level of body dissatisfaction. CONCLUSIONS Social support, health locus of control and self-esteem appear to be important correlates of eating disorder symptoms and body image in adolescents with diabetes and their typically developing peers.
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Affiliation(s)
- Laura A Kaminsky
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Diabetes Clinic, Alberta Children's Hospital, Calgary, Alberta, Canada.
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15
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Pinhas-Hamiel O, Hamiel U, Levy-Shraga Y. Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment. World J Diabetes 2015; 6:517-526. [PMID: 25897361 PMCID: PMC4398907 DOI: 10.4239/wjd.v6.i3.517] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/09/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Eating disorders (ED) are characterized by a persistent disturbance of eating that impairs health or psychosocial functioning. They are associated with increased rates of medical complications and mortality. Insulin omission is a unique purging behavior available to individuals with type 1 diabetes mellitus (T1DM). The standard treatment regimen for T1DM requires a major focus on food and eating patterns. Moreover, intensive insulin therapy is associated with increasing body weight. These factors, combined with the psychological burden of chronic disease management and depression, may contribute to ED. The comorbidity of ED in T1DM patients is associated with poorer glycemic control and consequently higher rates of diabetes complications. Early recognition and adequate treatment of ED in T1DM is essential.
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Kaminsky LA, Dewey D. The Association between Body Mass Index and Physical Activity, and Body Image, Self Esteem and Social Support in Adolescents with Type 1 Diabetes. Can J Diabetes 2014; 38:244-9. [DOI: 10.1016/j.jcjd.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/11/2014] [Accepted: 04/22/2014] [Indexed: 12/15/2022]
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Scheuing N, Bartus B, Berger G, Haberland H, Icks A, Knauth B, Nellen-Hellmuth N, Rosenbauer J, Teufel M, Holl RW. Clinical characteristics and outcome of 467 patients with a clinically recognized eating disorder identified among 52,215 patients with type 1 diabetes: a multicenter german/austrian study. Diabetes Care 2014; 37:1581-9. [PMID: 24623022 DOI: 10.2337/dc13-2156] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare clinical characteristics and outcome of type 1 diabetes mellitus (T1DM) between patients with and without a clinically recognized eating disorder (ED). RESEARCH DESIGN AND METHODS A total of 52,215 T1DM patients aged 8 to <30 years from the prospective diabetes data acquisition system DPV were analyzed. A total of 467 patients had an additional diagnosis of ED according to DSM-IV criteria (anorexia nervosa [AN], n = 141 [female: 94.3%]; bulimia nervosa [BN], n = 62 [90.3%]; and EDs not otherwise specified, including binge-eating disorder [EDNOS], n = 264 [74.2%]). Groups were compared using multivariable regression. Cox proportional hazard ratios were calculated for the association between ED and retinopathy. RESULTS After adjustment for age, sex, and duration of diabetes, patients with ED revealed higher HbA1c (no ED vs. AN, BN, or EDNOS, respectively: 8.29 ± 0.01% [67.1 ± 0.1 mmol/mol] vs. 8.61 ± 0.15% [70.6 ± 1.6 mmol/mol], 9.11 ± 0.23% [76.1 ± 2.5 mmol/mol], or 9.00 ± 0.11% [74.9 ± 1.2 mmol/mol]) and a higher rate of pathological insulin injection sites (48.4 vs. 64.3, 64.1, or 62.1%). Furthermore, ketoacidosis (5.7 ± 0.1 vs. 12.1 ± 2.1, 18.0 ± 4.1, or 12.9 ± 1.6 events per 100 person-years) and hospitalization (54.9 ± 0.3 vs. 89.3 ± 6.0, 132.0 ± 12.7, or 91.0 ± 4.4 per 100 person-years) were more common, and duration of hospital stay was longer (4.81 ± 0.01 vs. 11.31 ± 0.21, 18.05 ± 0.48, or 8.44 ± 0.13 days per year). All P values were <0.05. Patients with BN and EDNOS had a 2.5-fold (95% CI 1.3-4.8) and a 1.4-fold (0.8-2.3) higher risk for retinopathy, whereas AN patients had no increased risk (0.9 [95% CI 0.4-2.3]). CONCLUSIONS Diabetes health care professionals should be aware of comorbid EDs in pediatric/young-adult T1DM patients. An ED diagnosis is associated with worse metabolic control and higher rates of diabetes complications.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
| | - Béla Bartus
- Pediatric Clinic, Olgahospital Stuttgart, Stuttgart, Germany
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Holger Haberland
- Hospital for Children and Adolescents, Sana Hospital Berlin Lindenhof, Berlin, Germany
| | - Andrea Icks
- Department of Public Health, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyInstitute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
| | - Burkhild Knauth
- Diabetes Centre, Christian Association of Youth Villages Berchtesgaden Health-Education-Employment, Berchtesgaden, Germany
| | | | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
| | - Martin Teufel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
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19
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Baechle C, Castillo K, Straßburger K, Stahl-Pehe A, Meissner T, Holl RW, Giani G, Rosenbauer J. Is disordered eating behavior more prevalent in adolescents with early-onset type 1 diabetes than in their representative peers? Int J Eat Disord 2014; 47:342-52. [PMID: 24375553 DOI: 10.1002/eat.22238] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite modern therapeutic regimens, youths with Type 1 diabetes may be at increased risk of mental and behavioral disorders. In this study, the prevalence of disordered eating behavior (DEB) in intensely treated children and adolescents with early-onset Type 1 diabetes and peers from the general population was compared. METHOD Data from 629 patients from a population-based, nationwide survey (54.1% male, mean age 15.3 years) with early-onset Type 1 diabetes of at least 10 years duration were compared with data from 6,813 participants of the German KiGGS study (51.3% male, mean age 14.6 years). The generic SCOFF questionnaire was used as screening instrument to identify participants with symptoms of DEB. Both groups were compared with multivariable regression analysis adjusting for sociodemographic covariates. RESULTS 31.2% of the female and 11.7% of the male diabetic patients and 28.9% of the females and 15.2% of the males in the comparison group were SCOFF-positive (SCOFF score ≥2; p > .05). The odds for symptoms of eating disorders were 3.7% higher in female and 4.3% lower in male patients with diabetes than in the comparison group, but the differences were not significant. 20.5% of the female and 18.5% of the male diabetic patients reported insulin restriction at least three times per week. DISCUSSION Children and adolescents with early-onset Type 1 diabetes of long duration do not seem to be more frequently SCOFF-positive than peers. However, as insulin restriction is practiced in a substantial portion of patients, attention for insulin restriction in diabetes care is essential.
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Affiliation(s)
- Christina Baechle
- German Diabetes Centre, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
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20
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Pinhas-Hamiel O, Hamiel U, Greenfield Y, Boyko V, Graph-Barel C, Rachmiel M, Lerner-Geva L, Reichman B. Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus. Int J Eat Disord 2013; 46:819-25. [PMID: 23674378 DOI: 10.1002/eat.22138] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Intentional insulin omission is a unique inappropriate compensatory behavior that occurs in patients with type 1 diabetes mellitus, mostly in females, who omit or restrict their required insulin doses in order to lose weight. Diagnosis of this underlying disorder is difficult. We aimed to use clinical and laboratory criteria to create an algorithm to assist in the detection of intentional insulin omission. METHOD The distribution of HbA1c levels from 287 (181 females) patients with type 1 diabetes were used as reference. Data from 26 patients with type 1 diabetes and intentional insulin omission were analysed. The Weka (Waikato Environment for Knowledge Analysis) machine learning software, decision tree classifier with 10-fold cross validation was used to developed prediction models. Model performance was assessed by cross-validation in a further 43 patients. RESULTS Adolescents with intentional insulin omission were discriminated by: female sex, HbA1c>9.2%, more than 20% of HbA1c measurements above the 90th percentile, the mean of 3 highest delta HbA1c z-scores>1.28, current age and age at diagnosis. The models developed showed good discrimination (sensitivity and specificity 0.88 and 0.74, respectively). The external test dataset revealed good performance of the model with a sensitivity and specificity of 1.00 and 0.97, respectively. DISCUSSION Using data mining methods we developed a clinical prediction model to determine an individual's probability of intentionally omitting insulin. This model provides a decision support system for the detection of intentional insulin omission for weight loss in adolescent females with type 1 diabetes mellitus.
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Affiliation(s)
- Orit Pinhas-Hamiel
- Maccabi Health Care Services, Juvenile Diabetes Center, Raanana, Israel; Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Wisting L, Frøisland DH, Skrivarhaug T, Dahl-Jørgensen K, Rø O. Disturbed eating behavior and omission of insulin in adolescents receiving intensified insulin treatment: a nationwide population-based study. Diabetes Care 2013; 36:3382-7. [PMID: 23963896 PMCID: PMC3816868 DOI: 10.2337/dc13-0431] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish the prevalence of disturbed eating behavior (DEB) and insulin omission among adolescents with type 1 diabetes using intensive insulin treatment in a nationwide population-based study. RESEARCH DESIGN AND METHODS The Diabetes Eating Problem Survey-Revised (DEPS-R) is a diabetes-specific screening tool for DEB. Clinical data and HbA1c were obtained from the Norwegian Childhood Diabetes Registry. RESULTS A total of 770 children and adolescents 11-19 years of age with type 1 diabetes completed the DEPS-R. A total of 27.7% of the females and 8.6% of the males scored above the DEPS-R cutoff. Participants scoring above the cutoff had significantly higher HbA1c (9.2% [77 mmol/mol]; SD, 1.6) than participants scoring below the cutoff (8.4% [68 mmol/mol]; SD, 1.3; P < 0.001). The prevalence of DEB increased significantly with age and weight, from 7.2% in the underweight group to 32.7% in the obese group, and from 8.1% in the youngest age-group (11-13 years) to 38.1% in the oldest age-group (17-19 years). A total of 31.6% of the participants reported insulin restriction and 6.9% reported insulin omission after overeating. Patients reporting insulin restriction had significantly higher HbA1c (9.0% [75 mmol/mol]; SD, 1.7) than nonrestrictors (8.3% [67 mmol/mol]; SD, 1.2; P < 0.001). CONCLUSIONS One-fourth of girls with type 1 diabetes scored above the cutoff for DEB and one-third reported skipping their insulin dose entirely at least occasionally after overeating. Both DEB and insulin restriction were associated with poorer metabolic control, which may increase the risk of serious late diabetes complications.
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Hanlan ME, Griffith J, Patel N, Jaser SS. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr Diab Rep 2013; 13:10.1007/s11892-013-0418-4. [PMID: 24022608 PMCID: PMC4002640 DOI: 10.1007/s11892-013-0418-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review is focused on the prevalence of eating disorders and disordered eating behaviors in individuals with type 1 diabetes. Recent research indicates higher prevalence rates of eating disorders among people with type 1 diabetes compared with their peers without diabetes. Eating disorders and disordered eating behaviors-especially insulin omission-are associated with poorer glycemic control and serious risk for increased morbidity and mortality. Screening should begin in pre-adolescence and continue through early adulthood, as many disordered eating behaviors begin during the transition to adolescence and may persist for years. Available screening tools and treatment options are reviewed. Given the complexity of diabetes management in combination with eating disorder treatment, it is imperative to screen early and often, in order to identify those most vulnerable and begin appropriate treatment in a timely manner.
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Affiliation(s)
- Margo E. Hanlan
- Preferred Pediatrics, 10600 Spotsylvania Avenue, Fredericksburg, VA, 540-604-9500 Fax: 540-604-9501
| | - Julie Griffith
- Joslin Diabetes Center, Boston, MA, 1 Joslin Place, Boston, MA, 617-732-2603 Fax: 617-309-2451
| | - Niral Patel
- Department of Pediatrics, Vanderbilt University, Nashville, TN, 2200 Children's Way, Nashville, TN, 615-343-6603 Fax: 615-875-7633
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University, Nashville, TN, 2200 Children's Way, Nashville, TN, 615-343-6603 Fax: 615-875-7633
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Wisting L, Frøisland DH, Skrivarhaug T, Dahl-Jørgensen K, Rø O. Psychometric properties, norms, and factor structure of the diabetes eating problem survey-revised in a large sample of children and adolescents with type 1 diabetes. Diabetes Care 2013; 36:2198-202. [PMID: 23536586 PMCID: PMC3714528 DOI: 10.2337/dc12-2282] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the psychometric properties of the Diabetes Eating Problem Survey-Revised (DEPS-R) in a large sample of young patients with type 1 diabetes, to establish norms, and to validate it against the Eating Attitudes Test-12 (EAT-12). RESEARCH DESIGN AND METHODS A total of 770 children and adolescents aged 11-19 years with type 1 diabetes completed the DEPS-R and the EAT-12. In addition, age- and sex-standardized BMI and HbA1c data were obtained from the Norwegian Childhood Diabetes Registry. In addition to tests of validity, principal axis factoring was conducted to investigate the factor structure of the 16-item DEPS-R. RESULTS The DEPS-R demonstrated satisfactory Cronbach α (0.89) and was significantly correlated with the EAT-12 (0.65; P < 0.01), indicating convergent validity. The mean (SD) DEPS-R scores were 11.0 (10.7) for the total sample and 7.7 (7.4) and 14.2 (2.4) for males and females, respectively. CONCLUSIONS This study replicates and extends previous research demonstrating the psychometric properties of the abbreviated 16-item DEPS-R. Findings support the utility of this important screening tool to identify disturbed eating in young patients with type 1 diabetes.
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Affiliation(s)
- Line Wisting
- Regional Eating Disorders Service, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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d'Emden H, Holden L, McDermott B, Harris M, Gibbons K, Gledhill A, Cotterill A. Disturbed eating behaviours and thoughts in Australian adolescents with type 1 diabetes. J Paediatr Child Health 2013. [PMID: 23199338 DOI: 10.1111/jpc.12014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To describe the presence and type of disturbed eating behaviours and thoughts in a combined male/female Australian sample of adolescents with type 1 diabetes, and examine the association of eating behaviours and thoughts with glycaemic control as evidenced by high glycosylated haemoglobin levels (HbA1c). METHODS In this cross-sectional descriptive study, 124 adolescents aged 13-18 years were invited to complete three self-administered questionnaires. The Youth Eating Disorder Examination Questionnaire (YEDE-Q) and the Eating Disorder Inventory -3 Risk Composite (EDI-3RC) assessed risk for an eating disorder. The third questionnaire, the Strengths and Difficulties Questionnaire (SDQ) assessed emotional and behavioural concerns. Clinical data were collected from the medical records, routine clinic appointments and the adolescent. RESULTS Any disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% vs. 25.9%). Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, although restraint was not evident in males. Insulin manipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use (0.8%) were less common. Regression analysis showed a significant association between HbA1c and more disturbed eating behaviours and thoughts which remained significant when adjusted for confounders. CONCLUSIONS High rates of disturbed eating behaviours and thoughts were seen in this Australian sample of adolescents with type 1 diabetes. High scores on both eating disorder measures were associated with poorer glycaemic control. These results highlight the need to screen for disordered eating in adolescents with type 1 diabetes.
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Affiliation(s)
- Helen d'Emden
- Queensland Diabetes Centre, Mater Health Services, Brisbane, Queensland, Australia.
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Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, Heller S. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta-analysis. Diabet Med 2013; 30:189-98. [PMID: 22913589 DOI: 10.1111/j.1464-5491.2012.03771.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS We report a systematic review to determine (1) prevalence of eating problems compared with peers and (2) the association between eating problems and glycaemic control in young adults with Type 1 diabetes. METHOD We conducted a systematic literature search via electronic databases and meta-analysis. Cohen's d (the mean difference score between Type 1 diabetes and comparison groups) was calculated for 13 studies that met inclusion criteria. RESULTS Eating problems [both disordered eating behaviour (39.3 and 32.5%; d = 0.52, 95% CI 0.10-0.94) and eating disorders (7.0 and 2.8%; d = 0.46, 95% CI 0.10-0.81)] were more common in adolescents with Type 1 diabetes compared with peers and both were associated with poorer glycaemic control (d = 0.40, 95% CI 0.17-0.64). In restricted analyses involving measures adapted for diabetes, associations between eating problems and poorer glycaemic control remained (d = 0.54, 95% CI 0.32-0.76). Disordered eating behaviour (51.8 and 48.1%; d = 0.06, 95% CI -0.05 to 0.21) and eating disorders (6.4 and 3.0%; d = 0.43, 95% CI -0.06 to 0.91) were more common in adolescents with Type 1 diabetes compared with peers, but differences were non-significant. CONCLUSIONS Eating problems are common among this age group. Future work in populations with Type 1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended.
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Affiliation(s)
- V Young
- Department of Psychology, NIHR CLAHRC for South Yorkshire, Medical School, University of Sheffield, Sheffield, UK.
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26
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d'Emden H, Holden L, McDermott B, Harris M, Gibbons K, Gledhill A, Cotterill A. Concurrent validity of self-report measures of eating disorders in adolescents with type 1 diabetes. Acta Paediatr 2012; 101:973-8. [PMID: 22591161 DOI: 10.1111/j.1651-2227.2012.02738.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. METHODS In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. RESULTS The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency; Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. CONCLUSION Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines individual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention.
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Affiliation(s)
- Helen d'Emden
- Queensland Diabetes Centre, Mater Health Services Brisbane, QLD, Australia.
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Young-Hyman DL, Davis CL. Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification. Diabetes Care 2010; 33:683-9. [PMID: 20190297 PMCID: PMC2827531 DOI: 10.2337/dc08-1077] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Deborah L Young-Hyman
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, Georgia, USA.
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Ackard DM, Vik N, Neumark-Sztainer D, Schmitz KH, Hannan P, Jacobs DR. Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications. Pediatr Diabetes 2008; 9:312-9. [PMID: 18466215 DOI: 10.1111/j.1399-5448.2008.00392.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a population-based sample of youth. SUBJECTS A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT). METHOD Participants completed surveys and anthropometric measurements of height and weight. RESULTS Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes. CONCLUSIONS Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.
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Schulze U, Holl R, Goldbeck L. Essstörungen und Typ-1-Diabetes im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
AIMS The aims were to describe the food habits of adolescents with Type 1 diabetes (Type 1 DM) and to compare them with healthy control subjects; to describe the distribution of energy-providing nutrients in patients and compare it with current recommendations and previous reports; and finally, to investigate associations between dietary intake and glycaemic control. METHODS One hundred and seventy-four adolescents with Type 1 DM and 160 age- and sex-matched healthy control subjects completed a validated food frequency questionnaire, and 38 randomly chosen patients completed a prospective 4-day food record. RESULTS Patients ate more regularly, and more often ate fruit and fruit juice, potatoes and root vegetables, meat, fish, egg, offal and sugar-free sweets than control subjects. Control subjects more often ate ordinary sweets and snacks. Patients chose coarse rye bread and dairy products with less fat to a greater extent than control subjects. Patients were heavier than control subjects. The intake of saturated fat was higher in patients compared with recommendations and, for boys with diabetes, the intake of protein was higher than recommended. Patients with poorer glycaemic control ate vegetables, fruit and fish less often than patients with better control. CONCLUSIONS The food habits of adolescents with Type 1 DM were healthier than those of control subjects. The intake of energy-providing nutrients was in line with current recommendations and showed improvements compared with previous reports, with the exception of fibre intake. The association between dietary intake and glycaemic control needs further investigation in prospective studies.
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Affiliation(s)
- M Lodefalk
- Department of Paediatric Diabetology and Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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