Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

Body mass index moderates the association between diabetes distress and objective self-management behaviours in adolescents with type 1 diabetes and elevated A1Cs

OBJECTIVE

To examine the cross-sectional associations between diabetes distress, BMI (zBMI; BMI z-score), objectively measured mean daily blood glucose readings and insulin boluses administered, and A1C in adolescents with type 1 diabetes (T1D) using insulin pumps.

METHODS

T1D self-management behaviour data were downloaded from adolescents' (N = 79) devices and mean daily frequency of blood glucose readings and insulin boluses were calculated. Diabetes distress was measured (Problem Areas in Diabetes-Teen questionnaire [PAID-T]), A1C collected, and zBMI calculated from height and weight. Three multiple linear regressions were performed with blood glucose readings, insulin boluses, and A1C as the three dependent variables and covariates (age, T1D duration), zBMI, diabetes distress, and the diabetes distress x zBMI interaction as independent variables.

RESULTS

Participants (55.7% female) were 14.9 ± 1.9 years old with T1D for 6.6 ± 3.4 years. zBMI moderated the relationship between diabetes distress and mean daily insulin boluses administered (b = -0.02, p = 0.02); those with higher zBMI and higher diabetes distress administered fewer daily insulin boluses. zBMI was not a moderator of the association between diabetes distress and blood glucose readings (b = -0.01, p = 0.29) or A1C (b = 0.002, p = 0.81).

CONCLUSIONS

Using objective behavioural data is useful for identifying how adolescent diabetes distress and zBMI affect daily bolusing behaviour amongst adolescent insulin pump users. Although distinct interventions exist to improve T1D self-management or diabetes distress, none addresses them together while considering zBMI. Decreasing diabetes distress could be especially important for youth with high zBMI.

Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis

AIMS

To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms.

METHODS

We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission.

RESULTS

A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21-0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24-0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ2 = 85.83, df = 8, p < .0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26-0.34) vs. 18 % (95 % Cl 0.14-0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13-0.33).

CONCLUSIONS

Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates.

Weight Management Behaviors are Associated with Elevated Glycemic Outcomes in Adolescents and Young Adults with Type 1 Diabetes

Many adolescents and young adults (AYAs) with type 1 diabetes (T1D) engage in weight management behaviors (i.e., trying to lose weight), and efforts to manage weight may impact glycemic control. We assessed objective/subjective weight status and weight management behaviors in a diverse sample of 76 AYAs with T1D, and examined differences in sociodemographic characteristics and A1c levels by the following categories: (1) Overweight BMI/weight management (n = 21), (2) overweight BMI/no weight management (n = 6), (3) in/below-range BMI/weight management (n = 25), (4) in/below-range BMI/no weight management (n = 24). Subjective overweight status was more common among late adolescents and females; female gender was associated with weight management behaviors. AYAs endorsing weight management behaviors evidenced higher A1c values than those who did not. Clinicians working with AYAs should be aware of associations among weight management and glycemic indicators and routinely screen for weight management behaviors. Future research should explore interventions to promote healthy lifestyle behaviors among AYAs.

Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study

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.

Diabetes distress and disordered eating behaviors in youth with type 1 diabetes: the mediating role of self-regulatory fatigue and the moderating role of resilience

BACKGROUND

Despite previous research on the association between diabetes distress and disordered eating behaviors (DEBs) among youth with type 1 diabetes (T1D), there is a lack of understanding regarding the underlying mechanisms. This study aimed to investigate the relationships between diabetes distress and DEBs, specifically examining whether self-regulatory fatigue mediated the relationship and whether resilience moderated this mediation.

METHODS

A cross-sectional study was performed among youth with T1D recruited from two diabetes centers in Nanjing, China. Measurement instruments included the problem areas in the diabetes-5 scale, the diabetes strengths and resilience measure for adolescents, the self-regulatory fatigue scale, and the Chinese version of diabetes eating problem survey-revised. Mediation and moderated mediation analyses were conducted.

RESULTS

A total of 185 youths with T1D were involved in the current study. The results indicated that diabetes distress positively predicted DEBs. Self-regulatory fatigue partially mediated the association between diabetes distress and DEBs, accounting for 50.88% of the overall effect. Additionally, the pathway from self-regulatory fatigue to DEBs was moderated by resilience.

CONCLUSION

The current study examined whether self-regulatory fatigue mediated the relationship between diabetes distress and DEBs and whether resilience moderated the connection between self-regulatory fatigue and DEBs. These findings add to the theoretical basis of how diabetes distress influences DEBs and help guide the incorporation of diabetes distress, self-regulatory fatigue, and resilience into DEBs reduction programs for youth with T1D.

Internet-delivered eating disorders prevention program for adolescent girls with type 1 diabetes: Acceptable and feasible

BACKGROUND

Adolescents with type 1 diabetes are at significantly increased risk for eating disorders and few interventions exist.

OBJECTIVE

This study examined the feasibility, acceptability, and preliminary effects of an internet-based eating disorders prevention program adapted specifically for adolescent girls with type 1 diabetes.

PARTICIPANTS AND METHODS

Thirty-five girls (16.2 ± 1.1 years) participated Body Project (T1D Style), a 4-week program consisting of four adolescent sessions focused on promoting illness acceptance, challenging sociocultural body image pressures, increasing social support, and teaching assertive communication. Caregivers participated in one session focused on fostering body image positivity and a healthy relationship with food. Pre-intervention, post-intervention, and 3-month follow-up surveys assessed disordered eating, body dissatisfaction, thin-ideal internalization, diabetes acceptance, diabetes distress, and quality of life. Cohen's d effect sizes were calculated at post-intervention and follow-up. Program acceptability was assessed at post-intervention. Manual fidelity and homework completion were monitored.

RESULTS

High manual fidelity, retention, and homework completion were achieved. Quantitative and qualitative feedback from teens and caregivers suggested high acceptability. Large effects (d = 1.35-0.83) were observed for dieting, body dissatisfaction, diabetes distress, diabetes acceptance, and diabetes-related quality of life at post-intervention, with large-medium effects (d = 1.16-0.58) at follow-up. Medium-small effects (d = 0.49-0.78) at post-intervention were observed for diabetes-specific disordered eating and thin-ideal internalization, with effects maintained at follow-up.

CONCLUSIONS

Results support the acceptability and feasibility of this targeted eating disorders prevention program for adolescent girls with type 1 diabetes. Future clinical trials are warranted to determine its effectiveness compared to a control condition.

Aus Sicht der Diabetespraxis: erwachsen werden mit Typ-1-Diabetes

Junge Erwachsene mit Typ-1-Diabetes tragen die Verantwortung für ihre Diabetestherapie weitgehend selbst, gleichzeitig genießen sie neu gewonnene Freiheiten und sind eher risikobereit. Die eigene Wohnung, Partnerschaft, Studium, Beruf und weitere Entwicklungsaufgaben stellen hohe Anforderungen. Diese sind oft schwer mit einer qualifizierten Diabetestherapie vereinbar. Nach der langjährigen persönlichen Bindung an das Team einer Kinderklinik ist der Wechsel in eine internistische Diabetesschwerpunktpraxis nicht immer reibungslos. Individuelle psychische Belastungen und ein unzureichendes Diabetesmanagement verstärken sich dabei gegenseitig. Diabetes verkörpert in diesem Lebensabschnitt genau das Gegenteil von all dem, was altersgemäß ist. Er erfordert einen strukturierten Tagesablauf, disziplinierte Ernährung, regelmäßige Arztbesuche und vorausschauendes Denken und Handeln. Die Analyse der CGM-Daten (CGM: kontinuierliche Glukosemessung [„continuous glucose monitoring“]) in der Diabetespraxis erlaubt detaillierte Einblicke in den persönlichen Alltag, die mit Scham- und Schuldgefühlen verbunden sein können. Ziel der Langzeitbehandlung ist es, alle diese Aspekte – aktuelle Lebensqualität, persönliche Ziele, Vermeidung akuter Diabeteskomplikationen und Prävention langfristiger kardiovaskulärer Folgekomplikationen – zu beachten und daraus partizipativ ein individuelles Behandlungskonzept zu entwickeln. Die wichtigste Aufgabe der Diabetespraxis ist dabei, junge Menschen auf ihrem individuellen Weg zu unterstützen, ihre Stärken anzuerkennen und sie durch Erfolge zu motivieren.

Depression in Diabetic Patients: What Is the Link With Eating Disorders? Results of a Study in a Representative Sample of Patients With Type 1 Diabetes

BACKGROUND AND PURPOSE

Comorbidity between diabetes and depression, and diabetes and eating disorders (ED) conveys significant diagnostic, clinical and therapeutic implications. The present study was conducted on a sample of adult outpatients affected by Type 1 Diabetes (T1DM) to assess lifetime prevalence of ED; current prevalence of depression and Disturbed Eating Behaviors (DEB) and their impact on glycemic control. We hypothesized that patients with depression would have higher rates of lifetime ED and current DEB. We hypothesized a significant and independent association between DEB and the prevalence of depression.

MATERIALS AND METHODS

The study was carried out using a cross-sectional design in a sample of 172 diabetic patients with T1DM aged from 17 to 55 years. Lifetime prevalence of ED according to DSM-5 criteria was assessed by means of the Module H modified of the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). The following questionnaires were used: Beck Depression Inventory-IA version (BDI-IA) and Diabetes Eating Problems Survey-Revised (DEPS-R), to assess respectively the current presence of depression and DEB. Socio-demographic, clinical, and laboratory data were also collected.

RESULTS

High rates of depression (35.5%) and DEB (19.2%) were observed in our sample of 172 adult outpatients with T1DM. Lifetime history of ED was present in 20.9% of the sample and was more frequently diagnosed in patients with current depression (34.4% vs. 13.9%, p = 0.002). Higher levels of DEB at DEPS-R significantly increased the odds of depression (adjOR: 1.09; 95% CI: 1.03-1.15; p = 0.003). The presence of DEB was associated with poor glycemic control. On the other hand, no association was found between depression and metabolic compensation.

CONCLUSION

Adult patients with T1DM and depression should be screened for ED and DEB. Treating DEB could positively impact both mood and glycemic control in this population. Further studies should be carried out on a larger patient population using a longitudinal design and an accurate method of evaluation to explore the complex relationship between diabetes, depression, ED, and DEB. Future research should investigate treatment strategies for DEB in T1DM patients and their impact on both psychopathological and metabolic outcomes.

The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.

The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.

Health-related quality of life in youth with type 1 diabetes: Associations with multiple comorbidities and mental health conditions

AIM

This cross-sectional study examined the associations of comorbid conditions on health-related quality of life (HRQOL) in 601 youth with type 1 diabetes. We evaluated associations between number of comorbid conditions (0, 1, ≥2) and particular comorbid conditions and youth HRQOL by self-report and parent proxy-report.

RESEARCH DESIGN AND METHODS

Youth with type 1 diabetes, aged 5-18 years, and their parents completed the PedsQL 4.0 Generic Core Scales self-report and parent proxy-report, respectively; they also reported youths' comorbid medical and mental health conditions. Separate linear regression models tested the relationship between number of comorbid conditions and specific comorbid conditions with youth-reported and parent proxy-reported HRQOL.

RESULTS

Youth with ≥2 comorbid conditions had significantly lower HRQOL by both self- and parent proxy-reports compared with youth with 0 or 1 comorbid condition (youth self-report: 0: 85 ± 12, 1: 85 ± 13, 2+: 78 ± 16, p = <0.0001; parent proxy-report: 0: 83 ± 12, 1: 81 ± 13, 2+: 74 ± 15, p = <0.0001). Amongst the comorbid conditions, only a mental health comorbidity was associated with lower HRQOL. For youth and parent proxy-reports, both the number of comorbidities (≥2) and the presence of a mental health comorbidity were significantly associated with lower HRQOL.

CONCLUSIONS

Health-related quality of life seems to be preserved in youth with type 1 diabetes unless confronted by multiple comorbidities as reported by youth and their parents. Our findings highlight the importance of tracking the presence of multiple comorbid conditions, possibly by reviewing problem and medication lists in the medical record, as well as screening for and addressing mental health conditions in routine diabetes care.

Insulin Restriction, Emotion Dysregulation, and Depressive Symptoms in Late Adolescents with Diabetes

OBJECTIVE

Insulin restriction occurs when an individual takes less insulin than recommended and is a serious concern for those with diabetes. General insulin restriction (IR) and insulin restriction for weight control (IRWC) have not been clearly distinguished in the literature, creating inconsistencies and limited understanding of factors that underlie this behavior. We examined whether these are distinct, and how emotion dysregulation and depressive symptoms relate to both forms of insulin restriction during late adolescence.

METHODS

As part of a larger study, late adolescents (ages 17-18) with type 1 diabetes (N = 236) completed measures of depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D]), facets of Difficulties In Emotion Regulation Scale (DERS), diabetes self-management behaviors, insulin restriction, and hemoglobin A1c (HbA1c).

RESULTS

IR and IRWC were not significantly associated with each other. IR was associated with self-management behaviors but not HbA1c, whereas the opposite was true for IRWC. All DERS subscales (M = 10.60-16.73) and CES-D (M = 16.56) were correlated with greater IRWC; CES-D and all but one DERS subscale were correlated with IR. Covariation with CES-D explained associations between DERS and IRWC. CES-D moderated associations with IR, indicating most subscales of the DERS were associated with IR only when CES-D was higher.

CONCLUSION

Emotion dysregulation and depressive symptoms are important correlates of the dangerous behavior of insulin restriction, but function differently when insulin is restricted specifically for weight control versus nonspecified reasons. Future research to understand these underlying processes will be necessary to develop emotion-based theory and evidence-based interventions for this dangerous behavior.

Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross-national investigation

OBJECTIVE

Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes-related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior).

RESEARCH DESIGN AND METHODS

Cohorts of Belgian and Dutch parents of children and adolescents (6-18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration.

RESULTS

The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02-0.08), and not behavioral regulation.

CONCLUSIONS

Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes.

Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis

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.

Health Care Transition in Type 1 Diabetes: Perspectives of Diabetes Care and Education Specialists Caring for Young Adults

PURPOSE

The purpose of the study was to describe experiences reported by diabetes care and education specialists caring for young adults with type 1 diabetes and to assess perceived deficiencies in clinical resources and barriers to care delivery.

METHODS

A 60-item electronic survey was fielded through email to members of the Association of Diabetes Care and Education Specialists (ADCES). Respondents completed a survey consisting of: (1) clinical practice characteristics and respondents' demographics; (2) health care transition components (eg, referrals) and their perceived importance; (3) framework of current clinical diabetes care delivery and perceived need for additional support; and (4) perceived barriers regarding clinical care delivery. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression.

RESULTS

Respondents (N = 531, 96% female, median years in practice = 13; interquartile range = 7-20) represented 49 states plus the District of Columbia. Although 88% of respondents reported reviewing pediatric records as important/very important, only 22% often/always reviewed them. Although 58% of respondents noted easy access to mental health care providers for young adults, 50% stated a need for additional resources. Furthermore, diabetes care and education specialists without easy access to mental health professionals were significantly more likely to report barriers to diabetes management for young adults with depression, substance abuse, eating disorders, and developmental disabilities.

CONCLUSION

Study findings highlight modifiable factors that may improve diabetes care coordination for transitioning young adults. Uniform approaches and increased access to trained mental health professionals may help support diabetes care and education specialists in their care of young adults with type 1 diabetes.

Screening and identification of disordered eating in people with type 1 diabetes: A systematic review

People with Type 1 diabetes (T1D) have been shown to be an at-risk group for the development of disordered eating behaviours, however, the validity of tools used to assess disordered eating behaviours in T1D is unclear. This review aimed to identify tools used to screen or identify disordered eating behaviours and eating disorders in people with T1D, and evaluate the validity and reliability of these tools. A systematic search strategy was conducted to October 2019 according to the PRISMA guidelines. The search strategy retrieved 2714 articles, with 100 articles describing 90 studies included in the review. Studies were predominantly conducted in adolescent females in clinical settings. Forty-eight individual tools were used across retrieved studies. Overall, the quality of tools reported in included articles was poor, with high risk of bias due to the use of non-validated tools (n = 44 articles) and few studies comparing to the reference standard (n = 10 articles) of a diagnostic interview. This review shows that a variety of tools have been used to screen and identify disordered eating behaviours and eating disorders in people with T1D. Future research including comparison to a gold standard diagnostic interview is warranted to further evaluate the validity and reliability of available tools.

25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt?

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.