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Hirvelä L, Haukka J, Keski-Rahkonen A, Sipilä PN. Eating disorders among people with and without type 1 diabetes: incidence and treatment in a nationwide population-based cohort. Diabetologia 2025; 68:766-777. [PMID: 39755842 PMCID: PMC11950106 DOI: 10.1007/s00125-024-06346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/12/2024] [Indexed: 01/06/2025]
Abstract
AIMS/HYPOTHESIS Eating disorders are over-represented in type 1 diabetes and are associated with an increased risk of complications, but it is unclear whether type 1 diabetes affects the treatment of eating disorders. We assessed incidence and treatment of eating disorders in a nationwide sample of individuals with type 1 diabetes and diabetes-free control individuals. METHODS Our study comprised 11,055 individuals aged <30 who had been diagnosed with type 1 diabetes in 1998-2010, and 11,055 diabetes-free control individuals matched for age, sex and hospital district. We ascertained incidence of eating disorders from hospital records using Poisson regression. Eating disorder treatment was assessed by new prescriptions for psychotropic medications and hospital treatment for eating disorders. RESULTS During a mean follow-up of 13.1 years, there were 175 incident cases of eating disorders among individuals with type 1 diabetes and 75 among the control individuals (adjusted incidence rate ratio 2.35; 95% CI 1.80, 3.09). The prescription of psychotropic medications was similar among eating disorder patients with and without type 1 diabetes. However, those with type 1 diabetes received outpatient hospital treatment for their eating disorder less often than those without diabetes (mean 3.32 vs 5.33 outpatient care visits per year [adjusted difference 1.24; 95% CI 0.39, 2.08]). CONCLUSIONS/INTERPRETATION People with type 1 diabetes are more likely to be diagnosed with eating disorders than their diabetes-free peers. However, they receive less outpatient hospital treatment for their eating disorders despite their greater risk for major adverse health outcomes. These findings emphasise the need for targeted eating disorder treatment for people with type 1 diabetes.
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Affiliation(s)
- Leon Hirvelä
- Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Pyry N Sipilä
- Department of Public Health, University of Helsinki, Helsinki, Finland
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2
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Propper-Lewinsohn T, Shalitin S, Gillon-Keren M, Yackobovitch-Gavan M, Liberman A, Phillip M, Elran-Barak R. Glycemic Variability and Disordered Eating Among Adolescents and Young Adults with Type 1 Diabetes: The Role of Disinhibited Eating. Diabetes Technol Ther 2025; 27:113-120. [PMID: 39284171 DOI: 10.1089/dia.2024.0267] [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] [Indexed: 09/26/2024]
Abstract
Background and Aims: Disordered eating behaviors (DEB) are common among individuals with type 1 diabetes (T1D). Glycemic variability, potentially harmful in T1D, may reveal distinct characteristics between those with higher versus lower variability, particularly concerning DEB. Our aim was to evaluate the prevalence of DEB and associated risk factors among adolescents and young adults with T1D and to investigate unique factors associated with DEB across different levels of glycemic variability. Methods: An observational, cross-sectional study was conducted with 147 individuals with T1D, aged 13-21 years. Data were collected from medical charts, personal technological devices for assessing glycemic variability, and self-reported questionnaires, including assessments of DEB. Results: DEB were found in 62 (42.1%) individuals, and 41.5% achieved the glycemic variability (% coefficient of variation) target ≤36%. Among individuals with low glycemic variability, DEB were positively associated with diabetes distress (odds ratio [OR]: 1.14 [95% confidence interval or CI: 1.05-1.22], P < 0.001), longer diabetes duration (OR: 1.34 [95% CI: 1.05-1.70], P = 0.016) and lower socioeconomic-status (OR: 0.53 [95% CI: 0.31-0.90], P = 0.019). Among those with high glycemic variability, body mass index Z score (OR: 3.82 [95% CI: 1.48-9.85], P = 0.005), HbA1c (OR: 4.12 [95% CI: 1.33-12.80], P = 0.014), disinhibited eating (OR: 1.57 [95% CI: 1.14-2.15], P = 0.005), and tendency to lower socioeconomic status (OR: 0.75 [95% CI: 0.56-1.01], P = 0.065). Discussion: DEB are prevalent among adolescents and young adults with T1D and are associated with various risk factors. Factors associated with DEB vary across different levels of glycemic variability. Both low and high glycemic variability are associated with specific risk factors for DEB. One notable risk factor is diabetes-specific disinhibited eating among individuals with high glycemic variability, in contrast to those with low glycemic variability. Given these different risk factors, it may be prudent to adjust intervention programs to reduce DEB among T1D adolescents according to their glycemic variability levels.
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Affiliation(s)
- Tamar Propper-Lewinsohn
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Shlomit Shalitin
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Gillon-Keren
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Sciences, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Liberman
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Phillip
- The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Trojanowski PJ, Warnick J, Darling KE, Tanner B, Shomaker LB, O'Donnell HK. Weight stigma in pediatric type 1 diabetes: An associated risk for disordered eating? J Health Psychol 2025:13591053241311755. [PMID: 39819100 DOI: 10.1177/13591053241311755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2025] Open
Abstract
Adolescents with type 1 diabetes (T1D) have elevated eating disorder risk. No studies have examined weight stigma as a potential factor associated with disordered eating. This study investigated cross-sectional associations among weight-based victimization, weight bias internalization, and disordered eating in adolescents with T1D. Adolescents (12-17 years; N = 166) self-reported experiences of weight-based victimization from peers, family members, and healthcare professionals. The Weight Bias Internalization Scale (WBIS) and Diabetes Eating Problems Survey (DEPS-R) assessed internalized weight bias and disordered eating, respectively. In a series of multiple hierarchical linear regression analyses (controlling for zBMI, diabetes duration, HbA1c, sex), weight bias internalization, weight-based victimization, and frequency of weight-based victimization by peers, family, and healthcare professionals were all positively associated with disordered eating. Weight stigma is an understudied but potentially important factor to address in adolescents with T1D. Reducing weight stigma may be a promising, novel target for eating disorder prevention in this population.
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Affiliation(s)
- Paige J Trojanowski
- University of Colorado School of Medicine, USA
- Children's National Hospital, USA
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Niemelä PE, Leppänen HA, Voutilainen A, Möykkynen EM, Virtanen KA, Ruusunen AA, Rintamäki RM. Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis. Eat Behav 2024; 53:101863. [PMID: 38452627 DOI: 10.1016/j.eatbeh.2024.101863] [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: 08/28/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
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.
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Affiliation(s)
- Pia E Niemelä
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Hanna A Leppänen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Ari Voutilainen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Essi M Möykkynen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Kirsi A Virtanen
- Faculty of Medicine, Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Anu A Ruusunen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland; IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Reeta M Rintamäki
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Wellbeing Services County of North Savo, Puijonlaaksontie 2, 70210 Kuopio, Finland
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Ip EJ, Doroudgar S, Salehi A, Salehi F, Najmi M. Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus. Endocr Pract 2023; 29:849-854. [PMID: 37567472 DOI: 10.1016/j.eprac.2023.08.001] [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: 04/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. METHODS A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. RESULTS Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). CONCLUSION Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.
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Affiliation(s)
- Eric J Ip
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California; Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Aava Salehi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Fojan Salehi
- Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Mitra Najmi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California.
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Troncone A, Affuso G, Cascella C, Chianese A, Zanfardino A, Iafusco D. Prevalence and Multidimensional Model of Disordered Eating in Youths With Type 1 Diabetes: Results From a Nationwide Population-Based Study. J Pediatr Psychol 2023; 48:731-739. [PMID: 36921286 DOI: 10.1093/jpepsy/jsad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE The aim of this study was to report nationwide data of the prevalence of disordered eating behaviors (DEBs) in adolescents with type 1 diabetes (T1D) and to evaluate a multidimensional model of eating problems, analyzing how psychopathological problems are associated with DEBs and with metabolic control. METHODS This study was carried out using a cross-sectional design with a sample of 1,562 patients with T1D (812 male), aged 11-19 years. Participants were recruited from multiple pediatric diabetes centers (N = 30) located in northern, central, and southern Italy, and they individually completed the Diabetes Eating Problem Survey-Revised (DEPS-r) and the Youth Self-Report (YSR). Sociodemographic and clinical data were also gathered. Multiple-group structural equation modeling was used to investigate the relationships between internalizing/externalizing symptoms, DEBs, and glycosylated hemoglobin (HbA1c) values. RESULTS A total of 29.7% of the participants reported DEBs (DEPS-r scores ≥20), 42.4% reported insulin manipulation (IM). The prevalence of DEBs was higher for female participants (p ≤ .001). The model explains 37% of the variance in disordered eating, 12% in IM, and 21% in HbA1c values. Body mass index, externalizing symptoms, and internalizing symptoms were significantly and positively associated with DEBs, which in turn were significantly and positively associated with HbA1c values (all p ≤ .001). Externalizing (p ≤ .001) and internalizing (p ≤ .01) symptoms were also directly associated with HbA1c values. CONCLUSION Given the relevant prevalence of DEBs, their significant positive association with psychopathological symptoms, and their relationship with worse diabetes outcomes, regular psychological screening and support is needed to ensure the best care of adolescents with T1D.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | - Gaetana Affuso
- Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | | | - Angela Zanfardino
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Italy
| | - Dario Iafusco
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Italy
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Wetter SE, Driscoll KA. Commentary: From Recommendations to Reality: Assessment and Treatment of Adolescents With Type 1 Diabetes and Disordered Eating Behaviors. J Pediatr Psychol 2023; 48:740-742. [PMID: 37330674 DOI: 10.1093/jpepsy/jsad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023] Open
Affiliation(s)
- Sara E Wetter
- Department of Clinical and Health Psychology, University of Florida, USA
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8
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Uliana GC, Camara LN, Paracampo CCP, da Costa JC, Gomes DL. Characteristics of carbohydrate counting practice associated with adequacy of glycated hemoglobin in adults with type 1 diabetes mellitus in Brazil. Front Endocrinol (Lausanne) 2023; 14:1215792. [PMID: 37766694 PMCID: PMC10519792 DOI: 10.3389/fendo.2023.1215792] [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: 05/02/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Background The Carbohydrate Counting (CC) is directly associated with achieving glycemic control by people with Type 1 Diabetes Mellitus (T1DM). Therefore, this study aims to analyze characteristics of the CC practice associated with the adequacy of glycated hemoglobin (HbA1c) in adults with T1DM in Brazil. Methods The study was cross-sectional, carried out using an online form with questions about knowledge of CC, clinical, anthropometric, sociodemographic data, follow-up with health professionals and understanding of the concepts of CC. Pearson's chi-square test and binomial logistic regression analysis (p<0.05) were applied. Results 173 adults participated, of which 57.2% had increased HbA1c (≥7%). Having the diabetes duration <10 years (p=0.006), performing the CC at lunch (p=0.040) and dinner (p=0.018), using specific applications to perform the CC (p=0.001), having learned to perform CC with a nutritionist (p=0.037) and knowing how to correctly define the concepts of food bolus (p=0.001), correction bolus (p<0.001) and insulin/carbohydrate ratio (p<0.001) was associated with having adequate HbA1c (<7%). Participants who were undergoing CC practice were 3.273 times more likely to have adequate HbA1c and participants with diabetes duration <10 years were 2.686 times more likely to have adequate HbA1c. Conclusion It was concluded that variables transversal to CC favor adequate HbA1c values in adults with T1DM and that practicing CC and having a diabetes duration of less than 10 years are predictive factors of having adequate HbA1c.
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Affiliation(s)
| | | | | | | | - Daniela Lopes Gomes
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém, Brazil
- Faculty of Nutrition, Federal University of Pará, Belém, Brazil
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Viljoen D, King E, Harris S, Hollyman J, Costello K, Galvin E, Stock M, Schmidt U, Downs J, Sekar M, Newell C, Clark-Stone S, Wicksteed A, Foster C, Battisti F, Williams L, Jones R, Beglin S, Anderson S, Jebarsan T, Ghuys V, Ayton A. The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19. BJPsych Bull 2023; 48:1-9. [PMID: 37525957 PMCID: PMC11543318 DOI: 10.1192/bjb.2023.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023] Open
Abstract
AIMS/METHOD This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. RESULTS Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016-2017 and 2019-2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18-25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. CLINICAL IMPLICATIONS This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.
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Affiliation(s)
- David Viljoen
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- Ellern Mede Ridgeway and Ellern Mede Barnet, London, UK
| | - Emily King
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- Support to Recovery in Disordered Eating Service for 18–25s, Central and North West London NHS Foundation Trust, London, UK
| | - Sophie Harris
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- Royal Holloway University of London, London, UK
| | - Jonathan Hollyman
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
| | - Kate Costello
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- University of Edinburgh, Lothian NHS, Edinburgh, UK
| | - Eimear Galvin
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- Oxford Institute of Clinical Psychology Training and Research, Oxford University and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Melissa Stock
- Oxford Institute of Clinical Psychology Training and Research, Oxford University and Oxford Health NHS Foundation Trust, Oxford, UK
- Hertfordshire Community Eating Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Murali Sekar
- Hertfordshire Community Eating Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
- Priory Group, Chelmsford, UK
| | - Ciaran Newell
- Dorset Eating Disorders Service, Dorset Healthcare University NHS Foundation Trust, Poole, UK
- Bournemouth University, Poole, UK
| | - Sam Clark-Stone
- Eating Disorder Service, Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK
| | - Amy Wicksteed
- Sheffield Eating Disorder Service, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Caroline Foster
- Adult Eating Disorder Service, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | | | - Laura Williams
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
- Adult Eating Disorder Service, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Roshan Jones
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
- Oxford Child and Adolescent Eating Disorder Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Beglin
- Adult Eating Disorder Service, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | | | - Thuthirna Jebarsan
- Berkshire Eating Disorders Service, Berkshire Healthcare NHS, Bracknell, UK
- Talking Therapies, Berkshire Healthcare NHS, Bracknell, UK
| | - Viviane Ghuys
- Berkshire Eating Disorders Service, Berkshire Healthcare NHS, Bracknell, UK
| | - Agnes Ayton
- Oxford Health NHS Foundation Trust (OHFT), Oxford, UK
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Boccolini G, Marino M, Tiberi V, Iannilli A, Landi G, Grandi S, Tossani E, Cherubini V. A Risk Profile for Disordered Eating Behaviors in Adolescents with Type 1 Diabetes: A Latent Class Analysis Study. Nutrients 2023; 15:nu15071721. [PMID: 37049563 PMCID: PMC10096638 DOI: 10.3390/nu15071721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
(1) Background: This multi-center study aimed to identify a risk profile for disordered eating behaviors (DEBs) in youth with type 1 diabetes (T1D) based on their dietary intake, lipid profile, body mass index (BMI-SDS), and glycometabolic control. (2) Methods: Adolescents aged 11 to 18 years from five centers across Italy were recruited. Lipid profile, HbA1c, BMI-SDS, and dietary intake data were collected. The risk for developing DEBs was assessed via the Diabetes Eating Problems Survey-R (DEPS-R) questionnaire. A latent class analysis (LCA) was performed using a person-centered approach. (3) Results: Overall, 148 participants aged 11–18 (12.1, ±3.34), 52% males with a mean diabetes duration of 7.2 (±3.4), were enrolled. Based on the results of the DEBS-R score, LCA allowed us to highlight two different classes of patients which were defined as “at-risk” and “not at-risk” for DEB. The risk profile for developing DEBs is characterized by higher BMI—SDS (23.9 vs. 18.6), higher HbA1c (7.9 vs. 7.1%), higher LDL cholesterol (99.9 vs. 88.8 mg/dL), lower HDL cholesterol (57.9 vs. 61.3 mg/dL), higher proteins (18.2 vs. 16.1%), and lower carbohydrates (43.9 vs. 45.3%). Adolescents included in the “at-risk” class were significantly older (p = 0.000), and their parents’ SES was significantly lower (p = 0.041). (4) Conclusions: This study allowed us to characterize a risk profile for DEBs based on dietary behavior and clinical parameters. Early identification of the risk for DEBs allows timely intervention and prevention of behavior disorders.
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Albaladejo L, Périnet-Marquet P, Buis C, Lablanche S, Iceta S, Arnol N, Logerot S, Borel JC, Bétry C. High prevalence with no gender difference of likely eating disorders in type 1 mellitus diabetes on insulin pump. Diabetes Res Clin Pract 2023; 199:110630. [PMID: 36934794 DOI: 10.1016/j.diabres.2023.110630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
AIM The aim of this study was to determine the prevalence of likely eating disorders and insulin misuse in a prospective cohort of adults with type 1 diabetes mellitus (T1DM) treated with insulin pump therapy. METHODS This prospective study was held at the participants' home. The participants completed the SCOFF questionnaire as well as a question related to insulin misuse. Information about lifestyle, medical history, insulin pump and Continuous Glucose Monitoring (CGM) data were collected. RESULTS The analysis covered 198 participants with a median age of 51 [95% CI 38; 62] years. The prevalence of likely eating disorders was 21.7% (95% CI 16.3; 28.2) in the study population and 20.6% (95% CI 14.3; 28.6) and 24.2% (95% CI 14.6; 37.0) in males and females respectively. The prevalence of insulin misuse was 39.0% (95% CI 30.8; 47.7). There was no significant difference in prevalence between males and females for likely eating disorders and insulin misuse. The analysis of CGM data revealed no factors related to glycaemic control associated with likely eating disorders. CONCLUSION The results of this study indicate that the prevalence of likely eating disorders is high even in a middle-aged population with a T1DM and satisfactory glucose control.
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Affiliation(s)
- Laura Albaladejo
- Remedee Labs, 99 chemin de l'étoile, 38330 Montbonnot St Martin, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, MESP, 38000 Grenoble, France
| | | | - Claire Buis
- Adult Psychiatry Department, CHU de Grenoble, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble Alpes University Hospital, Grenoble, France
| | - Sylvain Iceta
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada; Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada
| | - Nathalie Arnol
- AGIR à dom, 36 chemin du Vieux Chêne, 38240 Meylan, France
| | - Sophie Logerot
- AGIR à dom, 36 chemin du Vieux Chêne, 38240 Meylan, France
| | | | - Cécile Bétry
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France.
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12
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Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:8. [PMID: 36650572 PMCID: PMC9847054 DOI: 10.1186/s40337-022-00717-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. METHODS The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. RESULTS A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. CONCLUSION Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia.
- Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW, 2006, Australia.
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
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13
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Elhabashy SA, Abd ElMalak MW, Elrassas HH, Thabet RA. Disordered eating and behaviors among young Egyptians with type 1 diabetes: risk factors and comorbidities. J Pediatr Endocrinol Metab 2022; 35:1385-1393. [PMID: 36127837 DOI: 10.1515/jpem-2022-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed to assess occurrence of eating disorders and its nature, associated risk factors, and comorbidities in a cohort of adolescents with type 1 diabetes (T1D). METHODS In this cross-sectional study, 138 patients were recruited to complete three questionnaires for assessment of eating disorder (ED); Eating Attitude Test (EAT-26) and Eat Behavior questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire version 6 (EDE-Q6) to assess diabetes-related medical outcomes. RESULTS Patients were categorized as having an ED according to predetermined cutoff value for each questionnaire. Of the 138 patients, 24 (17.4%) had risk for EDs by EAT-26 score, 53 (38.4%) have got orthorexia nervosa by ORTO-15 and 45 (32.6%) were having a disordered eating behavior by EDE-Q6. Patients with risk of EDs had lower mean ORTO-15 score (p=0.01), and higher mean Global EDE-Q6 (p<0.001). A positive correlation was found between EAT-26 scores and both age (p<0.0001) and body mass index (p<0.0001). ORTO-15 score was correlated with duration of diabetes (p=0.0418). Diabetic ketoacidosis, peripheral neuropathy, and microalbuminuria occurred frequently in patients with ED high score. Hypoglycemic episodes were reported more in those with high EAT-26 or Global EDE-Q6 scores. CONCLUSIONS Subclinical EDs and abnormal eating behaviors are common in Egyptian adolescents with T1D.
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14
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Trojanowski PJ, Frietchen RE, Harvie B, Mehlenbeck R, Fischer S. Internet-delivered eating disorders prevention program for adolescent girls with type 1 diabetes: Acceptable and feasible. Pediatr Diabetes 2022; 23:1122-1132. [PMID: 35869788 PMCID: PMC9804811 DOI: 10.1111/pedi.13395] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 07/20/2022] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
| | - Rachel E. Frietchen
- George Mason UniversityFairfaxVirginiaUSA,Brown University, Butler HospitalProvidenceRhode IslandUSA
| | - Blair Harvie
- George Mason UniversityFairfaxVirginiaUSA,University of Pittsburgh Medical Center, Western Psychiatric HospitalPittsburghPennsylvaniaUSA
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15
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Kremers SHM, Wild SH, Elders PJM, Beulens JWJ, Campbell DJT, Pouwer F, Lindekilde N, de Wit M, Lloyd C, Rutters F. The role of mental disorders in precision medicine for diabetes: a narrative review. Diabetologia 2022; 65:1895-1906. [PMID: 35729420 PMCID: PMC9213103 DOI: 10.1007/s00125-022-05738-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
This narrative review aims to examine the value of addressing mental disorders as part of the care of people with type 1 and type 2 diabetes in terms of four components of precision medicine. First, we review the empirical literature on the role of common mental disorders in the development and outcomes of diabetes (precision prevention and prognostics). We then review interventions that can address mental disorders in individuals with diabetes or at risk of diabetes (precision treatment) and highlight recent studies that have used novel methods to individualise interventions, in person and through applications, based on mental disorders. Additionally, we discuss the use of detailed assessment of mental disorders using, for example, mobile health technologies (precision monitoring). Finally, we discuss future directions in research and practice and challenges to addressing mental disorders as a factor in precision medicine for diabetes. This review shows that several mental disorders are associated with a higher risk of type 2 diabetes and its complications, while there is suggestive evidence indicating that treating some mental disorders could contribute to the prevention of diabetes and improve diabetes outcomes. Using technologically enabled solutions to identify mental disorders could help individuals who stand to benefit from particular treatments. However, there are considerable gaps in knowledge and several challenges to be met before we can stratify treatment recommendations based on mental disorders. Overall, this review demonstrates that addressing mental disorders as a facet of precision medicine could have considerable value for routine diabetes care and has the potential to improve diabetes outcomes.
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Affiliation(s)
- Sanne H M Kremers
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Petra J M Elders
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - David J T Campbell
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
| | - Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Maartje de Wit
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Medical Psychology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cathy Lloyd
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, Open University, Milton Keynes, UK
| | - Femke Rutters
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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16
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Oliveira Cunha MCS, Dutra FCS, Cavaleiro Brito LMM, Costa RF, Gaspar MWG, Sousa DF, Moura de Araújo MF, Queiroz MVO. Disordered eating behaviour and eating disorder among adolescents with type 1 diabetes: An integrative review. World J Meta-Anal 2022; 10:244-254. [DOI: 10.13105/wjma.v10.i5.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Type 1 diabetes (DT1) in adolescents brings behavioural changes, altered nutritional habits, and eating disorders.
AIM To identify and analyze the validated instruments that examine the disordered eating behaviour and eating disorders among adolescents with DT1.
METHODS An integrative review was accomplished based on the following databases: PubMed, LILACS, CINAHL, Scopus, Web of Science, and Reference Citation Analysis (RCA), including publications in Portuguese, English, or Spanish, without time limit and time published.
RESULTS The main instruments to evaluate disordered eating behaviour were The Diabetes Eating Problem Survey-Revised, The Diabetes Eating Problem Survey, and the eating attitudes test-26, and for eating disorders the main instruments used were The Bulimic Investigation Test of Edinburgh, The Binge Eating Scale, The Child Eating Disorder Examination, The five questions of the (Sick, Control, One, Fat and Food), and The Mind Youth Questionnaire. These instruments showed an effect in evaluating risks regarding nutritional habits or feeding grievances, with outcomes related to weight control, inadequate use of insulin, and glycaemia unmanageability. We did not identify publication bias.
CONCLUSION Around the world, the most used scale to study the risk of disordered eating behaviour or eating disorder is The Diabetes Eating Problem Survey-Revised. International researchers use this scale to identify high scores in adolescents with DT1 and a relationship with poorer glycemic control and psychological problems related to body image.
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Affiliation(s)
| | | | | | - Rejane Ferreira Costa
- Department of Health Family, Oswaldo Cruz Foundation, Eusébio 61773-272, Ceará, Brazil
| | - Maria Wendiane Gueiros Gaspar
- Department of Health Science, University for the International Integration of Afro-Brazilian Lusophony, Redenção 62790-000, Ceará, Brazil
| | - Danilo Ferreira Sousa
- Department of Nursing, University for the International Integration of Afro-Brazilian Lusophony, Redenção 62790-000, Brazil
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17
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Priesterroth L, Grammes J, Strohm EA, Kubiak T. Disordered eating behaviours and eating disorders in adults with type 1 diabetes (DEBBI): rational and design of an observational longitudinal online study. BMJ Open 2022; 12:e064863. [PMID: 36113939 PMCID: PMC9486289 DOI: 10.1136/bmjopen-2022-064863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Disordered eating behaviours (DEB) and eating disorders (ED) are among the most common mental health comorbidities of type 1 diabetes. However, research on diabetes-specific risk and protective factors is limited. To this end, comprehensive characterisations of DEB and ED in type 1 diabetes, as well as longitudinal research on the course of DEB and ED, are needed to gain more insight. The 'Disordered eating behaviours and eating disorders in diabetes type I' (DEBBI) study aims to describe DEB/ED and their correlates in people with type 1 diabetes, to identify key diabetes-specific, psychosocial risk and protective factors, and to describe the course of DEB over time. METHODS AND ANALYSIS The DEBBI study is a longitudinal online survey with follow-up assessments after 6, 12 and 18 months, targeted at adults who have been diagnosed with type 1 diabetes for at least 12 months. The survey covers data on diabetes diagnosis and self-management (eg, diabetes treatment and complications), lifestyle (eg, eating habits, physical activity), psychosocial well-being (eg, anxiety, depressive symptoms) and demographic and medical information. It includes validated instruments and self-generated items. One key aspect of the data analysis will be latent profile analyses to determine latent subtypes of DEB manifestation in people with type 1 diabetes and their courses over time, including data on the clinical picture and symptoms, behaviours and diabetes-specific complications. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the State Medical Chamber of Rhineland-Palatine, Germany (ID 2021-16040). Participants give informed written consent before starting the survey. The DEBBI study will provide more clarity in the so far inconsistent empirical evidence base and will help to inform research on prevention and intervention strategies that are tailored to diabetes-specific needs. TRIAL REGISTRATION NUMBER The study is registered with DRKS German Clinical Trials Register (DRKS00028833).
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Affiliation(s)
| | - Jennifer Grammes
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Edda Anna Strohm
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
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18
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Troncone A, Affuso G, Cascella C, Chianese A, Pizzini B, Zanfardino A, Iafusco D. Prevalence of disordered eating behaviors in adolescents with type 1 diabetes: Results of multicenter Italian nationwide study. Int J Eat Disord 2022; 55:1108-1119. [PMID: 35751499 PMCID: PMC9544556 DOI: 10.1002/eat.23764] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the prevalence of disordered eating behaviors (DEBs) in a large sample of Italian adolescents with type 1 diabetes and to explore potential demographic, clinical, and psychological differences (understood as emotional and behavioral problems) among adolescents with and without DEBs. METHOD Adolescents (11-19 years) with type 1 diabetes completed the Diabetes Eating Problems Survey-revised (DEPS-r) and the Youth Self Report (YSR). Demographic and clinical data were also collected. RESULTS Of 690 adolescents with type 1 diabetes (mean age 14.97 ± 1.81, n = 337 girls) assessed in this study, 28.1% (21% boys, 35% girls) were DEPS-r positive (score ≥ 20). Girls had higher DEPS-r total scores (p < .0001, d = .42) than boys, although no age differences were found in mean DEPS-r total scores (p = .961). In both genders, adolescents with DEBs had significantly higher zBMI (p < .0001, d = .52) and HbA1c values (p < .0001, d = .54) and showed more emotional and behavioral problems (both as internalizing and externalizing problems) than those without DEBs (all p < .0001). These differences were largely confirmed in all age groups. Adolescents reporting insulin misuse had higher HbA1c values (p = .001, d = .26), higher DEPS-r mean scores (p < .0001, d = 1.07), and greater psychological problems (all p < .001) than those who did not. DISCUSSION DEBs are prevalent among adolescents with type 1 diabetes, and those with eating problems showed adverse clinical and psychological conditions. Routine screening for DEBs and of general psychological condition should be a fundamental part of diabetes care, especially during adolescence. PUBLIC SIGNIFICANCE STATEMENT This nationwide study indicated that DEBs are common in adolescents with T1D, and those suffering from them show poorer clinical conditions and higher emotional and behavioral problems. As such, it offers important contributions for those working with EDs and in the T1D field, as it provides a deeper understanding of the co-occurring DEBs-emotional/behavioral problems in youths with T1D and highlights the importance of continuous monitoring of their psychological condition by a multidisciplinary team.
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Affiliation(s)
- Alda Troncone
- Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly
| | - Gaetana Affuso
- Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly
| | - Crescenzo Cascella
- Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly
| | - Antonietta Chianese
- Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly
| | - Barbara Pizzini
- Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized SurgeryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized SurgeryUniversity of Campania “Luigi Vanvitelli”NaplesItaly
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19
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Holder M, Kapellen T, Ziegler R, Bürger-Büsing J, Danne T, Dost A, Holl RW, Holterhus PM, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Neu A. Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2022; 130:S49-S79. [PMID: 35913059 DOI: 10.1055/a-1624-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Holder
- Klinikum Stuttgart, Olgahospital, Department of Pediatric Endocrinology and Diabetology, Germany
| | - Thomas Kapellen
- Department of Paediatrics and Adolescent Medicine, University Hospital, Leipzig, Germany
| | - Ralph Ziegler
- Practice for Paediatrics and Adolescent Medicine, Focus on Diabetology, Münster, Germany
| | - Jutta Bürger-Büsing
- Association of Diabetic Children and Adolescents, Diabetes Center, Kaiserslautern, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Axel Dost
- Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital Schleswig-Holstein, Kiel Campus, Germany
| | - Beate Karges
- Endocrinology and Diabetology Section, University Hospital, RWTH Aachen University, Germany
| | - Olga Kordonouri
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Klemens Raile
- Virchow Hospital, University Medicine, Berlin, Germany
| | - Roland Schweizer
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Rainer Stachow
- Sylt Specialist Hospital for Children and Adolescents, Westerland, Germany
| | - Verena Wagner
- Joint Practice for Paediatrics and Adolescent Medicine, Rostock, Germany
| | | | - Andreas Neu
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
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20
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Eating disorders and carbohydrate metabolism interrelations. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Eating disorders are characterised by persistent disturbances in eating behavior, resulting in severe carbohydrate homeostasis changes. The aim of the study is to review mutual correlations between eating disorders, with emphasis on anorexia nervosa, and carbohydrate metabolism, including glycemia and the levels of relevant hormones.
Material and methods: A priori general inclusion criteria were established and included patients with eating disorders or with glucose metabolism disorders. A MEDLINE database review was carried out. Relevant articles have been extracted and approved by supervisor.
Results: 40 studies got included in the review. Patients with active anorexia nervosa display low levels of fasting and postprandial glucose, decreased lipid metabolism, and decreased pancreatic endocrine activity. Insulin levels remain changed even after patient’s re-nourishment – insulin response tends to be delayed and decreased compared to patients without anorexia history. Eating disorders are associated with poorer glycemic control and a higher percentage of diabetic complications in patients with pre-existing diabetes – mostly type I. There are also reports of higher carbohydrate metabolism disturbances among patients with eating disorders.
Conclusions: Carbohydrate metabolism disorders and eating disorders are clearly interrelated, although data on the nature of these relationships are still lacking. Treatment of eating disorders is not possible without normalizing eating patterns, thus also carbohydrate metabolism. However, it is not usual to monitor the mental state in terms of eating disorders potential development in patients during the treatment of carbohydrate disorders. According to existing data, this approach should be changed due to the risk of anorexia nervosa and other eating disorders in this group.
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21
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Watt A, Ng AH, Sandison A, Fourlanos S, Bramley A. Prevalence of disordered eating in adults with type 1 diabetes in an Australian metropolitan hospital. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e974-e980. [PMID: 34250682 DOI: 10.1111/hsc.13500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 04/06/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to establish the prevalence of disordered eating behaviours and establish its identifiable factors in adults with T1D attending a large tertiary hospital service. In this cross-sectional study, 199 participants with TID, aged 18-65 years, completed the revised Diabetes Eating Problem Survey-Revised (DEPS-R). Additional demographic and medical data obtained included age, sex, BMI, HbA1C, duration of diabetes and number of hospital admissions within 12 months (including diabetic ketoacidosis). A DEPS-R score of ≥20, indicative of disordered eating behaviour, was evident in 31% of participants. A DEPS-R score of ≥20 was associated with being female (39% females vs. 23.3% males; p = .016) and a high HbA1c (8.9% [7.8-10.2] vs. 8.0% [7.3-8.7], median [IQR], p < .001). The prevalence of disordered eating behaviours increased significantly with BMI, from 21.3% in the healthy BMI group (18.5-24.9 kg/m2 ) to 37.1% in the group with BMI > 25 kg/m2 (p = .02). A DEPS-R score of ≥20 was often driven by questions related to a desire to lose weight, meal patterns and glycaemic control. While these behaviours may be attributed to desirable self-management behaviours for adults with T1D, the DEPS-R is still a useful tool to identify patients with potential disordered eating behaviours and the need for dietetic intervention.
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Affiliation(s)
- Arleen Watt
- Clinical Nutrition Department, Royal Melbourne Hospital, Melbourne, Australia
| | - Ashley H Ng
- Discipline of Dietetics and Human Nutrition, La Trobe University, Bundoora, Vic., Australia
| | - Ashley Sandison
- Diabetes and Endocrinology Department, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Spiros Fourlanos
- Diabetes and Endocrinology Department, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Andrea Bramley
- Discipline of Dietetics and Human Nutrition, La Trobe University, Bundoora, Vic., Australia
- Workforce Innovation, Strategy, Education & Research (WISER) Unit, Monash Health, Clayton, Vic., Australia
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22
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Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review protocol. J Diabetes Metab Disord 2022; 21:1207-1215. [PMID: 35673417 PMCID: PMC9167269 DOI: 10.1007/s40200-022-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
Objective This systematic review aims to investigate the key socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. Methods A pre-specified search strategy will be used to search for studies in the electronic databases and citation indexes: PubMed, EMBASE, Web of Science, and PsycINFO. Two researchers will screen the title and the abstract independently, then will read and critically appraise the full text of each included study. A third independent reviewer will resolve disagreements in data extraction until consensus. Data will be extracted using the Population, Exposure, Outcomes, Study characteristics framework. Study selection will follow the updated guideline for reporting systematic reviews (PRISMA 2020) and will take place from 15 October 2021 to 1 January 2022. The methodological quality and risk of bias of the observational studies will be assessed by the JBI Critical Appraisal Checklist for Cohort and JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results A qualitative narrative synthesis will present the characteristics and the quality of studies and the outcomes of concern. Conclusion Based on the contemporary literature, this review will synthesize the evidence on the socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. The findings will help design patient-centered interventions to promote adherence to insulin in this age group, guide patients’ consultations and diabetes self-management education (DSME) programs. Protocol registration: PROSPERO ID: CRD42021233074.
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Salah NY, Hashim MA, Abdeen MSE. Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control. J Eat Disord 2022; 10:46. [PMID: 35379350 PMCID: PMC8981863 DOI: 10.1186/s40337-022-00571-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/24/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Disordered eating behaviour (DEB) represents a significant morbidity among people with type-1 diabetes (T1D). Continuous-subcutaneous insulin infusion (CSII) improves glycemic control and psychological wellbeing in those with T1D. However, its relation to DEB remains obscure. OBJECTIVES To compare DEB among adolescents with T1D on CSII versus basal-bolus regimen and correlate it with body image, HbA1C and depression. METHODS Sixty adolescents with T1D (30 on CSII and 30 on basal-bolus regimen), aged 12-17 years were studied focusing on diabetes-duration, insulin therapy, exercise, socioeconomic standard, hypoglycemic attacks/week and family history of psychiatric illness. Anthropometric measures, HbA1C, binge eating scale (BES), body image tool, patient health questionnaire-9 (PHQ9) and the Mini-KID depression scale were assessed. RESULTS Among the studied adolescents with T1D, six had DEB (10%), 14 had poor body-image perception (23.3%), 42 had moderate body-image perception (70%) and 22 had depression (36.7%). Adolescents with T1D on CSII had significantly lower BES (p = 0.022), Mini-KID depression (p = 0.001) and PHQ9 (p = 0.02) than those on basal-bolus regimen. BES was positively correlated to depression (p < 0.001), HbA1C (p = 0.013) and diabetes-duration (p = 0.009) and negatively correlated to body-image (p = 0.003). CONCLUSION DEB is a prevalent comorbidity among adolescents with T1D, with higher frequency in those on basal-bolus regimen than CSII.
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Affiliation(s)
- Nouran Yousef Salah
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, 25 Korash Street, Nasr City, Cairo, Egypt.
| | - Mostafa Ahmad Hashim
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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24
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Wagner G, Zeiler M, Karwautz A, Schneider A, Rami-Merhar B, Berger G. Personality, Coping and Developmental Conditions in Female Adolescents and Young Adults with Type 1 Diabetes: Influence on Metabolic Control and Quality of Life. Front Psychiatry 2022; 12:809015. [PMID: 35356383 PMCID: PMC8960069 DOI: 10.3389/fpsyt.2021.809015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To assess personality factors, coping, developmental conditions and quality of life in female adolescents and young adults with type 1 diabetes (T1D) and high vs.low HbA1c. Methods Patients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included. HIGH-A1c was defined as HbA1c > 7.5%, LOW-A1c as HbA1c ≤ 7.5% and compared to a sample of 56 age-matched female healthy controls. Self-rating questionnaires were used to assess psychosocial factors: Children's Depression Inventory (CDI); Junior Temperament and Character Inventory (J-TCI); Eating Disorders Inventory-2 (EDI-2); KIDCOPE; Subjective Family Image Test (SFIT) and Inventory of Life Quality in Children and Adolescents(ILC). Results T1D patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum BMI, higher depression score, and higher frequency of diabetic ketoacidosis in the last year. They showed significantly higher levels of fatigue, lower levels of taking responsibility, lower ability to set goals and lower self-acceptance, as well as higher levels of ineffectiveness, lower levels of emotional attachment within the family, in particular with the fathers, and used negative coping strategies more often compared to patients with LOW-A1c. Furthermore, they reported significantly higher burden of illness and lower quality of life. Conclusions Disadvantageous personality and coping styles as well as developmental conditions should be addressed in the treatment of female adolescents with T1D with management problems.
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Affiliation(s)
- Gudrun Wagner
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andrea Schneider
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf, Vienna, Austria
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25
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Köstner K, Geirhos A, Ranz R, Galler A, Schöttler H, Klose D, Feldhahn L, Flury M, Schaaf K, Holterhus PM, Meissner T, Warschburger P, Minden K, Temming S, Müller-Stierlin AS, Baumeister H, Holl RW. Angst und Depression bei Typ-1-Diabetes – Erste Ergebnisse des Screenings auf psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen im Rahmen des COACH-Konsortiums. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1589-7922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDie interdisziplinäre Forschungskooperation COACH-Konsortium (Chronic Conditions in Adolescents – Implementation and Evaluation of Patient-centered Collaborative Healthcare) untersucht die psychosoziale Situation von Jugendlichen und jungen Erwachsenen mit chronischen körperlichen Erkrankungen. Zur Untersuchung der psychischen Komorbidität wurden bisher 1.023 Patienten mit Diabetes mellitus Typ 1 im Alter von 12–21 Jahren bei Routinevorstellungen in der Klinik bzw. Ambulanz mittels der Screening-Fragebogen Patient Health Questionnaire (PHQ-9) und Generalized Anxiety Disorder Scale-7 (GAD-7) zu Angst- und Depressionssymptomen befragt. 29,8 % der Jugendlichen und jungen Erwachsenen zeigten ein auffälliges Screening-Ergebnis. Dabei wurden 17,8 % der Fragebogen zu Angstsymptomen und 25,6 % der Fragebogen zu Depressionssymptomen auffällig mit Gesamtscore-Werten ≥ 7 in GAD-7 bzw. PHQ-9 beantwortet. Patienten mit erhöhten Depressions- und Angstwerten wiesen im Mittel einen deutlich höheren medianen HbA1c-Wert als Zeichen einer schlechteren Stoffwechseleinstellung auf (8,33 [8,09; 8,56]) als Patienten mit unauffälligem Screening (7,58 [7,48; 7,68]; p < 0,0001). Angesichts der hohen Prävalenz auffälliger Depressions- und Angstwerte und der Assoziation mit höheren HbA1c-Werten sollte bei allen Jugendlichen mit Diabetes mellitus Typ 1 regelmäßig das Vorliegen psychischer Belastungen abgeklärt werden. Dies könnte eine frühzeitige Diagnose einer psychischen Komorbidität und Intervention ermöglichen. Auf der Basis der Studien im COACH-Projekt können nun evidenzbasierte Empfehlungen für die interdisziplinäre Gesundheitsversorgung von Jugendlichen mit chronischen körperlichen Erkrankungen erstellt werden, die die psychischen Komorbiditäten systematisch berücksichtigen.
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Affiliation(s)
- Katharina Köstner
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Sozialpädiatrisches Zentrum Garmisch-Partenkirchen
| | - Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm
| | - Ramona Ranz
- Institut für Epidemiologie und med. Biometrie, ZIBMT, Universität Ulm
| | - Angela Galler
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum
| | | | - Daniela Klose
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg
| | | | | | - Katja Schaaf
- Klinik für Kinder- und Jugendmedizin, Elisabeth-Krankenhaus Essen
| | - Paul-Martin Holterhus
- Klinik für Kinder- und Jugendmedizin I, Fachbereich Pädiatrische Endokrinologie und Diabetologie, Universitätsklinikum Schleswig-Holstein, UKSH, Campus Kiel
| | - Thomas Meissner
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | - Kirsten Minden
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum
- Deutsches Rheuma-Forschungszentrum Berlin
| | - Svenja Temming
- Charité – Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin
| | | | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm
| | - Reinhard W. Holl
- Institut für Epidemiologie und med. Biometrie, ZIBMT, Universität Ulm
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Gibbings NK, Kurdyak PA, Colton PA, Shah BR. Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders. Diabetes Care 2021; 44:1783-1787. [PMID: 34172488 DOI: 10.2337/dc21-0517] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/13/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the risk of diabetic ketoacidosis (DKA) and all-cause mortality among adolescents and young adults with type 1 diabetes with and without an eating disorder. RESEARCH DESIGN AND METHODS With use of population-level health care administrative data covering the entire population of Ontario, Canada, all people with type 1 diabetes aged 10-39 years as of January 2014 were identified. Individuals with a history of eating disorders were age- and sex-matched 10:1 with individuals without eating disorders. All individuals were followed for 6 years for hospitalization/emergency department visits for DKA and for all-cause mortality. RESULTS We studied 168 people with eating disorders and 1,680 age- and sex-matched people without eating disorders. Among adolescents and young adults with type 1 diabetes, 168 (0.8%) had a history of eating disorders. The crude incidence of DKA was 112.5 per 1,000 patient-years in people with eating disorders vs. 30.8 in people without eating disorders. After adjustment for baseline differences, the subdistribution hazard ratio for comparison of people with and without eating disorders was 3.30 (95% CI 2.58-4.23; P < 0.0001). All-cause mortality was 16.0 per 1,000 person-years for people with eating disorders vs. 2.5 for people without eating disorders. The adjusted hazard ratio was 5.80 (95% CI 3.04-11.08; P < 0.0001). CONCLUSIONS Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of DKA and nearly sixfold increased risk of death compared with their peers without eating disorders.
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Affiliation(s)
- Nicole K Gibbings
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul A Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Patricia A Colton
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada .,ICES, Toronto, Ontario, Canada.,Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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27
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Han H, Yi B, Zhong R, Wang M, Zhang S, Ma J, Yin Y, Yin J, Chen L, Zhang H. From gut microbiota to host appetite: gut microbiota-derived metabolites as key regulators. MICROBIOME 2021; 9:162. [PMID: 34284827 PMCID: PMC8293578 DOI: 10.1186/s40168-021-01093-y] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 05/25/2023]
Abstract
Feelings of hunger and satiety are the key determinants for maintaining the life of humans and animals. Disturbed appetite control may disrupt the metabolic health of the host and cause various metabolic disorders. A variety of factors have been implicated in appetite control, including gut microbiota, which develop the intricate interactions to manipulate the metabolic requirements and hedonic feelings. Gut microbial metabolites and components act as appetite-related signaling molecules to regulate appetite-related hormone secretion and the immune system, or act directly on hypothalamic neurons. Herein, we summarize the effects of gut microbiota on host appetite and consider the potential molecular mechanisms. Furthermore, we propose that the manipulation of gut microbiota represents a clinical therapeutic potential for lessening the development and consequence of appetite-related disorders. Video abstract.
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Affiliation(s)
- Hui Han
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China
- Precision Livestock and Nutrition Unit, Gembloux Agro-Bio Tech, University of Liège, Passage de Déportés 2, 5030, Gembloux, Belgium
| | - Bao Yi
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China
| | - Ruqing Zhong
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China
| | - Mengyu Wang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China
| | - Shunfen Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China
| | - Jie Ma
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410128, China
| | - Yulong Yin
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410128, China
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, 410125, China
| | - Jie Yin
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410128, China.
| | - Liang Chen
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China.
| | - Hongfu Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing, 100193, China.
- College of Animal Science and Technology, Hunan Agricultural University, Changsha, 410128, China.
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28
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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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29
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Oldham-Cooper R, Semple C. Prevention and early help for eating disorders in young people with type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:656-668. [PMID: 33601920 DOI: 10.1177/1359104521994172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is building evidence that early intervention is key to improving outcomes in eating disorders, whereas a 'watch and wait' approach that has been commonplace among GPs and other healthcare professionals is now strongly discouraged. Eating disorders occur at approximately twice the rate in individuals with type 1 diabetes compared to the general population. In this group, standard eating disorder treatments have poorer outcomes, and eating disorders result in a particularly high burden of morbidity. Therefore, our first priority must be prevention, with early intervention where disordered eating has already developed. Clinicians working in both eating disorders and diabetes specialist services have highlighted the need for multidisciplinary team collaboration and specific training, as well as improved treatments. We review the current evidence and future directions for prevention, identification and early intervention for eating disorders in children and young people with type 1 diabetes.
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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
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30
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Priesterroth L, Grammes J, Clauter M, Kubiak T. Diabetes technologies in people with type 1 diabetes mellitus and disordered eating: A systematic review on continuous subcutaneous insulin infusion, continuous glucose monitoring and automated insulin delivery. Diabet Med 2021; 38:e14581. [PMID: 33826771 DOI: 10.1111/dme.14581] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023]
Abstract
AIMS In this systematic review, we aimed (1) to identify and describe research investigating the use of advanced diabetes technologies (continuous subcutaneous insulin infusion, CSII; continuous glucose monitoring, CGM; automated insulin delivery, AID) in people with type 1 diabetes (T1DM) and disordered eating and (2) to discuss potential (dis)advantages of diabetes technology use in this population, derived from previous research. METHODS We conducted a systematic literature search in two electronic databases for English articles published between 2000 and 2020 addressing eating disorders and/or dysfunctional eating behaviours and diabetes technology use in children, adolescents and adults with T1DM (PROSPERO ID CRD42020160244). RESULTS Of 70 publications initially identified, 17 were included. Overall, evidence on the use of diabetes technologies in people with T1DM and disordered eating is scarce. The majority of the studies reports findings on CSII in people with T1DM and dysfunctional eating behaviours or eating disorders. Findings predominantly stem from observational data and are, in most cases, secondary findings of the respective studies. Providing the greatest flexibility in diabetes management, CSII may have benefits in disordered eating. CGM data may complement the diagnostic process of disordered eating with a physiological indicator of insulin restriction (i.e. time spent in hyperglycaemia). CONCLUSIONS Results on possible (dis)advantages of diabetes technology use in people with T1DM and disordered eating are based on observational data, small pilot trials and anecdotical evidence from case reports. Prospective data from larger samples are needed to reliably determine potential effects of diabetes technology on disordered eating in T1DM.
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Affiliation(s)
- Lilli Priesterroth
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Jennifer Grammes
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Mona Clauter
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
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31
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Tan JO, Spector-Hill I. Identifying and managing eating disorders in type 1 diabetes mellitus: An all-Wales study. Clin Child Psychol Psychiatry 2021; 26:617-628. [PMID: 34159830 DOI: 10.1177/13591045211009591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating disorders. AIM To understand the level of knowledge and confidence amongst healthcare professionals in Wales regarding co-morbid T1DM and eating disorder presentations, identification and treatment. RESULTS We conducted a survey of 102 Welsh clinicians in primary care, diabetes services and eating disorder services. 60.8% expressed low confidence in identification of co-morbid T1DM and eating disorders. Respondents reported fewer cases seen than would be expected. There was poor understanding of co-morbid T1DM and eating disorders: 44.6% identified weight loss as a main symptom, 78.4% used no screening instruments, and 80.3% consulted no relevant guidance. The respondents expressed an awareness of their lack of knowledge and the majority expressed willingness to accept training and education. CONCLUSION We suggest that priority must be given to education and training of all healthcare professionals in primary care, diabetes services and mental health services who may see patients with co-morbid T1DM and eating disorders.
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Tittel SR, Dunstheimer D, Hilgard D, Knauth B, Fröhlich-Reiterer E, Galler A, Wurm M, Holl RW. Coeliac disease is associated with depression in children and young adults with type 1 diabetes: results from a multicentre diabetes registry. Acta Diabetol 2021; 58:623-631. [PMID: 33483854 PMCID: PMC8076130 DOI: 10.1007/s00592-020-01649-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/28/2020] [Indexed: 02/06/2023]
Abstract
AIMS To analyse the association between coeliac disease (CD) and depression in children, adolescents, and young adults with type 1 diabetes (T1D). METHODS We included 79,067 T1D patients aged 6-20 years, with at least six months of diabetes duration, and treatment data between 1995 and 2019 were documented in the diabetes patient follow-up registry. We categorized patients into four groups: T1D only (n = 73,699), T1 + CD (n = 3379), T1D + depression (n = 1877), or T1D + CD + depression (n = 112). RESULTS CD and depression were significantly associated (adjusted OR: 1.25 [1.03-1.53]). Females were more frequent in both the depression and the CD group compared with the T1D only group. Insulin pumps were used more frequently in T1D + CD and T1D + depression compared with T1D only (both p < .001). HbA1c was higher in T1D + depression (9.0% [8.9-9.0]), T1D + CD + depression (8.9% [8.6-9.2]), both compared with T1D only (8.2% [8.2-8.2], all p < .001). We found comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders more frequently in the T1D + CD + depression group compared with T1D only (all p < .001). CONCLUSIONS CD and depression are associated in young T1D patients. The double load of T1D and CD may lead to an increased risk for depression. Depression was associated with additional psychological and neurological comorbidities. Aside from imperative CD screening after T1D diagnosis and regular intervals, depression screening might be helpful in routine care, especially in patients with diagnosed CD.
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Affiliation(s)
- Sascha René Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Désirée Dunstheimer
- Paediatrics and Adolescent Medicine, Medical Faculty University of Augsburg, Augsburg, Germany
| | | | - Burkhild Knauth
- Department of Pediatrics and Adolescent Medicine, CJD Berchtesgaden, Berchtesgaden, Germany
| | - Elke Fröhlich-Reiterer
- Division of General Pediatrics, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Wurm
- Clinic St. Hedwig, University Children’s Hospital Regensburg (KUNO Clinics), University of Regensburg, Regensburg, Germany
| | - Reinhard Walter Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Galler A, Tittel SR, Baumeister H, Reinauer C, Brosig B, Becker M, Haberland H, Hilgard D, Jivan M, Mirza J, Schwab J, Holl RW. Worse glycemic control, higher rates of diabetic ketoacidosis, and more hospitalizations in children, adolescents, and young adults with type 1 diabetes and anxiety disorders. Pediatr Diabetes 2021; 22:519-528. [PMID: 33470512 DOI: 10.1111/pedi.13177] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/27/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
The aim of the study was to explore the metabolic characteristics and outcome parameters in youth with type 1 diabetes and anxiety disorders. HbA1c levels, rates of severe hypoglycemia, diabetic ketoacidosis (DKA), and hospital admission in children, adolescents, and young adults with type 1 diabetes and an anxiety disorder from 431 diabetes-care-centers participating in the nationwide German/Austrian/Swiss/Luxembourgian diabetes survey DPV were analyzed and compared with youth without anxiety disorders. Children, adolescents, and young adults with type 1 diabetes and anxiety disorders (n = 1325) had significantly higher HbA1c (8.5% vs. 8.2%), higher rates of DKA (4.2 vs. 2.5 per 100 patient-years), and higher hospital admission rates (63.6 vs. 40.0 per 100 patient-years) than youth without anxiety disorders (all p < 0.001). Rates of severe hypoglycemia did not differ. Individuals with anxiety disorders other than needle phobia (n = 771) had higher rates of DKA compared to those without anxiety disorders (4.2 vs. 2.5 per 100 patient-years, p = 0.003) whereas the rate of DKA in individuals with needle phobia (n = 555) was not significantly different compared to those without anxiety disorders. Children, adolescents, and young adults with anxiety disorders other than needle phobia had higher hospitalization rates (73.7 vs. 51.4 per 100 patient-years) and more inpatient days (13.2 vs. 10.1 days) compared to those with needle phobia (all p < 0.001). Children, adolescents, and young adults with type 1 diabetes and anxiety disorders had worse glycemic control, higher rates of DKA, and more hospitalizations compared to those without anxiety disorders. Because of the considerable consequences, clinicians should screen for comorbid anxiety disorders in youth with type 1 diabetes.
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Affiliation(s)
- Angela Galler
- Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha R Tittel
- Institute for Epidemiology und Medical Biometry, ZIBMT, Universität Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
| | - Harald Baumeister
- Institut für Psychologie und Pädagogik, Klinische Psychologie und Psychotherapie, Universität Ulm, Ulm, Germany
| | - Christina Reinauer
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Burkhard Brosig
- Zentrum für Kinderheilkunde und Jugendmedizin, Familien-und Kinderpsychosomatik, Universitätsklinikum Gießen, Gießen, Germany
| | - Marianne Becker
- Paediatric Clinic, Paediatric Endocrinology and Diabetology (DECCP), Centre Hospitalier de Luxembourg, Luxembourg
| | - Holger Haberland
- Klinik für Kinder- und Jugendmedizin, Paediatric Diabetology, Sana-Kliniken Lichtenberg, Berlin, Germany
| | - Dörte Hilgard
- Kinder- und Jugendarztpraxis Dr. Dörte Hilgard, Witten, Germany
| | - Marcelus Jivan
- CJD Berchtesgaden, Christliches Jugenddorfwerk Deutschland e.V, Germany
| | - Joaquina Mirza
- Kinderkrankenhaus Amsterdamer Straße, Klinik für Kinder- und Jugendmedizin, Paediatric Diabetology, Kliniken Köln, Köln, Germany
| | - Julia Schwab
- Diabetes-Klinik Bad Mergentheim GmbH & Co. KG, Bad Mergentheim, Germany
| | - Reinhard W Holl
- Institute for Epidemiology und Medical Biometry, ZIBMT, Universität Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
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Merwin RM, Moskovich AA, Babyak M, Feinglos M, Honeycutt LK, Mooney J, Freeman SP, Batchelder H, Sangvai D. An open trial of app-assisted acceptance and commitment therapy (iACT) for eating disorders in type 1 diabetes. J Eat Disord 2021; 9:6. [PMID: 33407910 PMCID: PMC7789378 DOI: 10.1186/s40337-020-00357-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death. Conventional eating disorder (ED) treatments have been largely ineffective for T1D patients, indicating the need to tailor treatments to this patient population and the unique conditions under which ED symptoms emerge (in the context of a chronic illness with unrelenting demands to control blood glucose, diet and exercise). The current study was a pilot open trial of iACT, a novel intervention for EDs in T1D grounded in Acceptance and Commitment Therapy (ACT). iACT was based on the premise that ED symptoms emerge as individuals attempt to cope with T1D and related emotional distress. iACT taught acceptance and mindfulness as an alternative to maladaptive avoidance and control, and leveraged personal values to increase willingness to engage in T1D management, even when it was upsetting (e.g., after overeating). A tailored mobile application ("app") was used in between sessions to facilitate the application of ACT skills in the moment that individuals are making decisions about their diabetes management. METHODS Adults with T1D who met criteria for an ED completed 12 sessions of iACT (with three optional tapering sessions). In addition to examining whether treatment was acceptable and feasible (the primary aim of the study), the study also examined whether iACT was associated with increased psychological flexibility (i.e., the ability to have distressing thoughts/feelings about diabetes while pursuing personally meaningful values), and improvements in ED symptoms, diabetes management and diabetes distress. RESULTS Treatment was acceptable to T1D patients with EDs and feasible to implement. Participants reported increased psychological flexibility with diabetes-related thoughts/feelings, and less obstruction and greater progress in pursuing personal values. There were large effects for change in ED symptoms, diabetes self-management and diabetes distress from baseline to end-of-treatment (Cohen's d = .90-1.79). Hemoglobin A1c also improved, but the p-value did not reach statistical significance, p = .08. CONCLUSIONS Findings provide preliminary evidence for iACT to improve outcomes for T1D patients with EDs and support further evaluation of this approach in a controlled trial. TRIAL REGISTRATION NCT02980627 . Registered 8 July 2016.
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Affiliation(s)
- Rhonda M Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA.
| | - Ashley A Moskovich
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA
| | - Michael Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA
| | - Mark Feinglos
- Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center, Durham, NC, USA
| | - Lisa K Honeycutt
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA
| | - Jan Mooney
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA
| | - Sara P Freeman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA
| | - Heather Batchelder
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3842, Durham, NC, 27712, USA
| | - Devdutta Sangvai
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
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Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I. Priorities in the Interdisciplinary Approach of Specific Learning Disorders (SLD) in Children with Type I Diabetes Mellitus (T1DM). From Theory to Practice. Brain Sci 2020; 11:brainsci11010004. [PMID: 33374577 PMCID: PMC7822406 DOI: 10.3390/brainsci11010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A considerable endeavor had taken place in order to understand the associated challenges for children and adolescents with Specific Learning Disorder (SLD) and Type 1 Diabetes Mellitus (T1DM) but also in order to describe the necessary skills and approaches that the care givers have to develop to assist both children and parents. (1) Aim: The aim of this review is twofold. Firstly, to highlight the T1DM's potential impact on psychological well-being, on cognitive functioning and on school performance in children and adolescents who confront SLD. Secondly, to discuss the necessity of a multidiscipline approach of poor school performance in students with SLD and T1DM, presenting the serious contribution of care providers: (a) parents/carers in the family setting, (b) teachers and psychologists in the school setting and (c) health specialists (pediatricians, nutricians, nurses, child psychiatrists and psychologists) in the medical setting. (2) Methods: In this narrative literature review of 12 selected articles, each one studies a special aspect of approach, during the diagnosis and the treatment of individuals with T1DM and SLD. The review concerns the arising problems and difficulties in the adherence to diagnosis, the management of insulin, the mental and physical wellbeing, the school performance, the cognitive functioning and learning difficulties of patients. We tried to synthesize an interdisciplinary approach that involves collaboration between family, school and medical frame; facilitating children's and adolescents' difficulties management, as well as parent and teacher involvement during the intervention implementation. (3) Results: The main issues of concern were examined through the available literature, as different factors had to be re-examined in the previous studies, regarding the potential impact of T1DM in cognitive and psychological functioning, as well as the effects of the intervention/approach/treatment of children and adolescents with SLD and T1DM. (4) Conclusions: Although T1DM diagnosis and demanding treatment are a heavy burden for children and their families, T1DM may or may not be associated with a variety of academic and psychological outcomes. Despite the variability of the reviewed research design quality, it was clearly defined that the impact of T1DM is not uniform across educational and mental variables. Strengthening the children's physical, psychological and social wellbeing is an especially important factor, as it facilitates the insulin's management as well as the learning difficulties. This is possible by supporting the parental and teacher involvement in the intervention process. This review highlights the need to reduce the distance between theory/research and practice, in some of the proposed areas in this field of knowledge.
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Troncone A, Chianese A, Zanfardino A, Cascella C, Piscopo A, Borriello A, Rollato S, Casaburo F, Testa V, Iafusco D. Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: an exploratory study. J Eat Disord 2020; 8:76. [PMID: 33292623 PMCID: PMC7708884 DOI: 10.1186/s40337-020-00353-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed to explore the prevalence of DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls during the COVID-19 lockdown. METHODS In a cross-sectional study, 138 children and adolescents with T1D (aged 8.01-19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed an online survey about eating behaviors (ChEAT and EAT-26), anthropometric characteristics, and clinical characteristics. RESULTS 8.69% (N = 12) of participants with T1D and 13.4% (N = 37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients-whether children (total ChEAT score F(1, 157) = .104, p = .748) or adolescents (total EAT-26 score F(1, 255) = .135, p = .731)-and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (p < .0001), while HbA1c values remained unchanged (p = .110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138) = 20.411, p < .0001, η2 = .132, controls: F(1, 276) = 18.271, p < .0001, η2 = .063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores. CONCLUSIONS This exploratory study suggested that children and adolescents with T1D did not experience more DEB symptoms during the COVID-19 lockdown compared to healthy controls. Results revealed DEBs as more of a female adolescent developmental issue rather than a result of the challenges of living with a chronic illness under quarantine measures. Possible effects of parental pressure on their children's eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed.
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Affiliation(s)
- Alda Troncone
- University of Campania "Luigi Vanvitelli", Caserta, Italy.
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy.
| | - Antonietta Chianese
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Crescenzo Cascella
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Alessia Piscopo
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Anna Borriello
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Serena Rollato
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Francesca Casaburo
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Veronica Testa
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Dario Iafusco
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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Galler A, Hilgard D, Bollow E, Hermann T, Kretschmer N, Maier B, Mönkemöller K, Schiel R, Holl RW. Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control. Pediatr Diabetes 2020; 21:1050-1058. [PMID: 32506592 DOI: 10.1111/pedi.13065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/13/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. METHODS Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. RESULTS Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). CONCLUSIONS In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.
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Affiliation(s)
- Angela Galler
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | | | - Esther Bollow
- Institute for Epidemiology und Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
| | - Thomas Hermann
- Fachklinik Prinzregent Luitpold Scheidegg, Rehaklinik für Kinder und Jugendliche, Pädiatrische Diabetologie, Scheidegg, Germany
| | - Nicole Kretschmer
- AKK-Altonaer Kinderkrankenhaus gGmbH, Subsidiary of Universitätsklinikum Hamburg-Eppendorf (UKE), Paediatric Diabetology and Endocrinology and Child and Adolescent Psychiatry and Psychosomatics, Hamburg, Germany
| | - Berthold Maier
- Diabetes-Klinik Bad Mergentheim GmbH & Co. KG Bad Mergentheim, Kinder- und Jugend-Diabetologie, Bad Mergentheim, Germany
| | - Kirsten Mönkemöller
- Kliniken Köln, Kinderkrankenhaus Amsterdamer Straße, Klinik für Kinder- und Jugendmedizin, Pädiatrische Diabetologie, Köln, Germany
| | - Ralf Schiel
- MEDIGREIF Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Heringsdorf, Germany
| | - Reinhard W Holl
- Institute for Epidemiology und Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
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Sagsak E, Onder A, Peltek Kendirci HN, Yıldız M, Karaman Aksakal D, Karayurt U, Bıkmazer A, Çakıroğlu S, Sertçelik M. Clinical features of the diabetes eating problem survey-revised Turkish version in children and adolescent with type 1 diabetes. J Pediatr Endocrinol Metab 2020; 33:1307-1312. [PMID: 32809959 DOI: 10.1515/jpem-2020-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Abstract
Objectives We aim to delineate clinical characteristics that place individuals with type 1 diabetes (T1DM) at risk of developing eating problems by using Turkish version of diabetes eating problem survey-revised (DEPS-R). Methods The patients aged 9-18 years with T1DM who came to the pediatric endocrine outpatient clinic for control between February and December 2019 completed Turkish version of DEPS-R. Clinical and laboratory findings were obtained from patient files. Cases with a questionnaire score ≥20 were considered to be at risk for eating disorders (ED). Parents were informed when the results of the screening were positive, and were offered to child psychiatrist. Results The median scores obtained with the Turkish version of DEPS-R for the total sample, for females and males were 15, 16, and 13 respectively. The score was significantly higher among females compared to males (p<0.001). DEPS-R score positive group had higher age (mean [SD]=14.6 [2.7], p=0.009), BMI (mean [SD]=21.4 [3.2], p<0.001), HbA1c % (mean [SD]=9.37[2.3], p<0.001) and year of diabetes duration (mean [SD]=5.5 [3.6], p<0.001) compared to the negative group. Conclusions Early recognition and adequate treatment of ED in T1DM is essential. DEPS-R is sensitive in identifying young people with ED.
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Affiliation(s)
- Elif Sagsak
- Istanbul Gaziosmanpasa Training and Research Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Asan Onder
- Istanbul Medeniyet University Göztepe Training and Research Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Havva Nur Peltek Kendirci
- Hitit University Erol Ucok Training and Research Hospital, Pediatric Endocrinology Clinic, Corum, Turkey
| | - Metin Yıldız
- Istanbul Medeniyet University Göztepe Training and Research Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Derya Karaman Aksakal
- Istanbul Medeniyet University Göztepe Training and Research Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Umran Karayurt
- Hitit University Erol Ucok Training and Research Hospital, Pediatric Endocrinology Clinic, Corum, Turkey
| | - Alperen Bıkmazer
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Child Psychiatry Clinic, Istanbul, Turkey
| | - Süleyman Çakıroğlu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Child Psychiatry Clinic, Istanbul, Turkey
| | - Mehmet Sertçelik
- Hitit University Erol Ucok Training and Research Hospital, Child Psychiatry Clinic, Corum, Turkey
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40
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Ayar D, Ozturk C, Bektas M, Bober E, Grey M. The effect of metabolic control, self-efficacy, and quality of life on emotional eating in the adolescents with type 1 diabetes mellitus. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
PURPOSE OF REVIEW This review describes the characteristics of patients with eating disorders in both type 1 and type 2 diabetes and the principles of their treatment. RECENT FINDINGS The combination of type 1 diabetes and an eating disorder is sometimes known as "diabulimia". The hallmark of the condition is that the patient deliberately takes an inadequate amount of insulin in order control their body weight (insulin restriction). Other disordered eating behaviours, such as dietary restriction, self-induced vomiting and binge eating, may also be present but typical anorexia nervosa is rare. There is an increased prevalence of eating disorders in adolescents with type 1 diabetes, which is estimated at 7%. The combination of type 1 diabetes and an eating disorder leads to elevated levels of HbA1c and an increased risk of both acute and chronic complications. Screening is recommended but rarely carried out. Management requires an understanding of the inter-relationships between eating behaviour, mood, blood glucose and insulin administration. Treatment aims to introduce a regular eating pattern and support the patient to increase their insulin dose gradually. Eating disorders also occur in those with type 2 diabetes, where binge eating disorder is the most common diagnosis. Eating disorders are common in both type 1 and type 2 diabetes, with an increased prevalence of complications in type 1. Treatment requires an understanding of both diabetes and eating behaviour.
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Affiliation(s)
- Anthony P Winston
- Clinic for Eating Disorders and Diabetes, Aspen Centre, Coventry and Warwickshire Partnership Trust, Warwick, UK.
- Schoen Clinic Newbridge, Birmingham, UK.
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Saßmann H, Dehn-Hindenberg A, Jördening M, Huhn F, Landgraf R, Lange K. Gestörtes Essverhalten und psychosoziale Versorgungssituation
junger Menschen mit Typ 1 Diabetes. Psychother Psychosom Med Psychol 2020; 70:449-456. [DOI: 10.1055/a-1142-6705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Zusammenfassung
Einleitung Gestörtes Essverhalten oder klinisch relevante
Essstörungen in Verbindung mit Typ 1 Diabetes haben schwerwiegende
Folgen für die Qualität der Stoffwechseleinstellung und die
langfristige gesundheitliche Prognose Betroffener. Eine frühzeitige
Diagnose und qualifizierte therapeutische Interventionen können bereits
bei gestörtem Essverhalten dazu beitragen, vorzeitige
mikrovaskuläre Schädigungen zu vermeiden. In dieser Studie
wurden für eine Gruppe junger Menschen mit Typ 1 Diabetes, die an einem
4-tägigen Camp teilnahmen, die Prävalenz essgestörten
Verhaltens und die spezifische psychosoziale Versorgungssituation
untersucht.
Material und Methoden Während eines bundesweit ausgeschriebenen
Diabetescamps für junge Menschen (16–29 Jahre) beantworteten die
Teilnehmenden Fragen zu ihrer aktuellen Diabetesbehandlung, zu
diabetesspezifischen Belastungen (PAID-5) sowie zur psychosozialen Versorgung im
Rahmen der ambulanten Langzeittherapie. Symptome gestörten Essverhaltens
wurden mit einem diabetesspezifischen Screeningfragebogen, dem Diabetes Eating
Problem Survey-Revised (DEPS-R), erhoben. Eine lineare multiple Regression wurde
berechnet, um Prädiktoren gestörten Essverhaltens zu
identifizieren.
Ergebnisse An der Umfrage beteiligten sich 308 junge Menschen mit Typ 1
Diabetes (Alter 21,4±3,4 Jahre; 73% weiblich; Diabetesdauer
10,2±5,9 Jahre; 74% in internistischer Behandlung). Bei
28,2% der Befragten ergaben sich Hinweise auf ein gestörtes
Essverhalten (17% der Männer, 32% der Frauen).
Teilnehmende mit einem auffälligen Summenwert im DEPS-R wurden nur zu
7% entsprechend psychologisch betreut. Das HbA1c, der BMI, die
diabetesspezifischen Belastungen, das Alter, die Diabetesdauer sowie das
Geschlecht erwiesen sich als signifikante Prädiktoren für das
Ausmaß gestörten Essverhaltens.
Diskussion Unter den Teilnehmenden eines Diabetescamps für junge
Menschen zeigten sich bei über einem Viertel Hinweise auf ein
gestörtes Essverhalten. Insgesamt waren davon junge Frauen
häufiger betroffen, weitere relevante Risikofaktoren waren ein
erhöhter BMI, ein höheres HbA1c und stärkere
diabetesspezifische Belastungen. Nur ein sehr geringer Anteil der jungen
Menschen mit Typ 1 Diabetes und gestörtem Essverhalten erhielt
psychologische Unterstützung.
Schlussfolgerung In der ambulanten diabetologischen Versorgung sollten
diabetesspezifische Screeninginstrumente und/oder gezielte
Screeningfragen insbesondere bei jungen Frauen regelmäßig
eingesetzt und die Ergebnisse mit den Betroffenen im Hinblick auf eine
weiterführende Behandlung besprochen werden.
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Affiliation(s)
- Heike Saßmann
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | | | - Mia Jördening
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Friederike Huhn
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Rüdiger Landgraf
- Bevollmächtigter des Vorstands, Deutsche Diabetes Stiftung,
München
| | - Karin Lange
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
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Abstract
PURPOSE OF REVIEW The aim of this review is to describe animal models that simulate the features of eating disorders. The literature pertaining to animal models that are of relevance for clinical eating disorders and the possible underpinning mechanisms was reviewed using PubMed, Ovid database and Google Scholar. RECENT FINDINGS New refinements of the circuits regulated by neurotransmitters and neuropeptides which instigate eating behaviours and the various feedback pathways which monitor acute and chronic nutrient status continue to be discovered. Moreover, work with the animal models that simulate the behavioural features and risk factors related to eating disorders is flourishing and providing new insights into possible causal mechanisms. For example, rodents develop binge-eating behaviours if they are intermittently exposed to processed, palatable foods and/or sugar adulterated drinks. This led to the controversial conceptualization of binge eating as a form of food addiction. Self-starvation taken to a fatal consequence such as occurs in anorexia nervosa can emerge in rodents exposed to triggers like social exclusion and/or the opportunity to exercise. SUMMARY There are plausible animal models for both anorexia nervosa and binge-eating disorders. These can be used to elaborate the theoretical models to explain the mechanisms underpinning eating disorders.
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Baechle C, Hoyer A, Stahl-Pehe A, Castillo K, Toennies T, Lindner LME, Reinauer C, Holl RW, Kuss O, Rosenbauer J. Course of Disordered Eating Behavior in Young People With Early-Onset Type I Diabetes: Prevalence, Symptoms, and Transition Probabilities. J Adolesc Health 2019; 65:681-689. [PMID: 31474433 DOI: 10.1016/j.jadohealth.2019.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/08/2019] [Accepted: 05/21/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE The aims of this study were to analyze the prevalence and course of disordered eating behavior (DEB) in adolescents with intensively treated type I diabetes, describe differences in age-specific DEB symptoms, and identify predictors of current DEB. METHODS Data were taken from 332/218 11- to 27-year-old participants (55.7% girls/women, mean age [SD] 17.8 [3.4] years, mean diabetes duration 14.9 [3.0] years) of two/three surveys of a Germany-wide longitudinal study on early-onset and long duration diabetes, respectively. A diabetes-adapted version of the SCOFF questionnaire was used to assess DEB. Both screening-based overall and age- and sex-specific prevalence of DEB and its symptoms were determined. To estimate transition probabilities between DEB states, first-order Markov transition models were implemented adjusting for previous sociodemographic, socioeconomic, and diabetes-specific covariates. RESULTS The overall screening-based DEB prevalence among all 1,318 observations was 10.8% (95% confidence interval [CI]: 9.2%, 12.6%) with age-specific differences in symptom prevalence. Transition probabilities for developing/persistent DEB were twofold higher among female than male participants (risk ratio [RR] 2.3 [1.4, 3.9]/2.1 [1.3, 3.4]). In multiple adjusted regression, previous DEB (odds ratio [OR] 2.8 [95% CI 1.4, 5.6]), follow-up time (ORper 1-year increase 3.4 [1.4, 8.0]), and sex (ORgirls/women 2.1 [1.1, 3.9]) were the most important predictors of current DEB with further weaker associations for previous age and HbA1c. CONCLUSIONS Our results contribute to better understanding the course of DEB in patients with early-onset diabetes and emphasize the relevance of regular DEB screenings including the age group of young adults.
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Affiliation(s)
- Christina Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany.
| | - Annika Hoyer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany
| | - Anna Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany
| | - Katty Castillo
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany
| | - Thaddaeus Toennies
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany
| | - Lena M E Lindner
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany
| | - Christina Reinauer
- University Children's Hospital, Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty at Heinrich Heine University, Düsseldorf, Germany
| | - Reinhard W Holl
- German Center for Diabetes Research, München-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Oliver Kuss
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany; Institute of Medical Statistics, Medical Faculty at Heinrich Heine University, Düsseldorf, Germany
| | - Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany; German Center for Diabetes Research, München-Neuherberg, Germany
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Peterson CM, Young-Hyman D, Fischer S, Markowitz JT, Muir AB, Laffel LM. Examination of Psychosocial and Physiological Risk for Bulimic Symptoms in Youth With Type 1 Diabetes Transitioning to an Insulin Pump: A Pilot Study. J Pediatr Psychol 2019; 43:83-93. [PMID: 28535306 DOI: 10.1093/jpepsy/jsx084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/05/2017] [Indexed: 01/07/2023] Open
Abstract
Objectives This study tested hypotheses drawn from a risk model positing that psychosocial risk plus disease-related and treatment factors contribute to bulimic symptoms in youth with type 1 diabetes (T1D) transitioning to an insulin pump. The goal of this study was to examine whether disease-related factors, particularly disease- and treatment-based disruption in hunger and satiety, contribute to report of bulimic symptoms in youth with T1D after accounting for psychosocial risk factors. Methods 43 youth (ages 10-17, 54% female) with established T1D were recruited before transition from multiple daily injections to insulin-pump therapy from three tertiary pediatric diabetes centers. Participants completed measures of bulimic symptoms, depressive symptoms dietary restraint, and the Diabetes Treatment and Satiety Scale, a diabetes-specific questionnaire assessing hunger and satiety cues and eating behavior in response to blood glucose levels and treatment. Results Hierarchical multiple regression was used to assess contributions of psychosocial and disease-based risk to report of bulimic symptoms. After assessing the contributions of body mass index, body image dissatisfaction, and dietary restraint, a significant 2-way interaction emerged between depression and diabetes-related uncontrollable hunger related to bulimic symptoms (β = 1.82, p < .01). Conclusions In addition to psychosocial risk, disease- and treatment-based hunger and satiety dysregulation appear to be important factors contributing to report of bulimic symptoms in youth with T1D. These preliminary findings have significant treatment implications for bulimic symptoms in youth with T1D.
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Affiliation(s)
- Claire M Peterson
- Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center
| | - Deborah Young-Hyman
- Office of Behavioral and Social Science Research, Office of the Director, NIH
| | | | | | - Andrew B Muir
- Department of Pediatrics, Emory University School of Medicine
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Cecilia-Costa R, Volkening LK, Laffel LM. Factors associated with disordered eating behaviours in adolescents with Type 1 diabetes. Diabet Med 2019; 36:1020-1027. [PMID: 30582670 PMCID: PMC6591109 DOI: 10.1111/dme.13890] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/31/2022]
Abstract
AIMS To assess the occurrence of disordered eating behaviours in teenagers with Type 1 diabetes and to compare characteristics according to level of disordered eating behaviours. METHODS In this cross-sectional study, we collected adolescents' demographic and diabetes management data by parent-youth interview and chart review. Teenagers completed psychosocial surveys, including the Diabetes Eating Problem Survey-Revised (DEPS-R), a diabetes-specific measure of disordered eating behaviours. We categorized teenagers according to level of disordered eating behaviours: low, DEPS-R score <10; moderate, DEPS-R score 10-19; and high, DEPS-R score ≥20. RESULTS The 178 teenagers (48% girls) were aged 14.9±1.3 years, with diabetes duration of 7.4±3.7 years. Most (59%) had low, 26% had moderate, and 15% had high levels of disordered eating behaviours. Several biomedical and psychosocial characteristics differed by level of disordered eating behaviours. There were more girls in the moderate (62%) and high (65%) than in the low level of disordered eating behaviours group (37%; P=0.003) and more obese teenagers in the moderate (13%) and high (27%) groups than in the low group (4%; P=0.0003). Frequency of daily blood glucose monitoring decreased (P=0.0006) and HbA1c level increased (P=0.01) with greater level of disordered eating behaviours. A greater level of disordered eating behaviours was also associated with poorer treatment adherence, more negative affect regarding blood glucose monitoring, poorer quality of life, and more depressive symptoms (all P<0.0001), along with more diabetes-specific family conflict (P=0.01). CONCLUSIONS Identifying teenagers with Type 1 diabetes who have moderate and high levels of disordered eating behaviours may prevent progression to eating disorders and substantial morbidity by directing support and intervention efforts to those in need.
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Affiliation(s)
- R. Cecilia-Costa
- Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry and Psychology, Eating Disorders Section, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
- Department of Psychiatry and Psychology, Doctorat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - L. K. Volkening
- Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - L. M. Laffel
- Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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48
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Worse Metabolic Control and Dynamics of Weight Status in Adolescent Girls Point to Eating Disorders in the First Years after Manifestation of Type 1 Diabetes Mellitus: Findings from the Diabetes Patienten Verlaufsdokumentation Registry. J Pediatr 2019; 207:205-212.e5. [PMID: 30579582 DOI: 10.1016/j.jpeds.2018.11.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess indications of eating disorders in girls with type 1 diabetes mellitus (T1DM). STUDY DESIGN In total 31 556 girls aged >6 months and <23 years of age with T1DM from the Diabetes Patienten Verlaufsdokumentation (DPV) cohort were analyzed including 155 (0.49%) girls with anorexia nervosa, 85 (0.27%) girls with bulimia nervosa, 45 (0.14%) girls with binge eating disorder, and 229 (0.73%) girls with eating disorders not otherwise specified. Patient characteristics, weight changes, numbers of patients with severe hypoglycemia and diabetic ketoacidosis (DKA), changes of glycosylated hemoglobin A1c (HbA1c) levels, use of pumps, and prevalence of celiac disease and autoimmune thyroiditis were compared between girls with and without eating disorders. Multiple logistic regression analyses were performed. RESULTS Eating disorders were significantly associated with late pubertal age, nonusage of pumps, no migration background, increased HbA1c levels, increased frequencies of DKA and severe hypoglycemia, and celiac disease were not related to eating disorders. Significant differences in HbA1c levels, prevalence of DKA and severe hypoglycemia between girls with and without eating disorders were already detectable in the first years after onset of T1DM. A decrease of body mass index (BMI)-SDS increased the risk for comorbid anorexia nervosa (7.1-fold [95% CI 3.6-14.3] compared with stable BMI-SDS, 6.9-fold [95%CI 3.4-14.1] compared with increase of BMI-SDS). CONCLUSIONS Poor metabolic control and increased rates of DKA and severe hypoglycemia in the first years after manifestation of T1DM can be hints for eating disorders in girls with T1DM, and weight loss is specific for anorexia nervosa. These clinical features should lead to screening for eating disorders especially at a late pubertal age.
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49
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Berger G, Waldhoer T, Barrientos I, Kunkel D, Rami‐Merhar BM, Schober E, Karwautz A, Wagner G. Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria. Pediatr Diabetes 2019; 20:127-136. [PMID: 30267464 PMCID: PMC7379731 DOI: 10.1111/pedi.12784] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. METHODS Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. RESULTS Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation. CONCLUSIONS This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
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Affiliation(s)
- Gabriele Berger
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Thomas Waldhoer
- Department of Public Health, EpidemiologyMedical University ViennaViennaAustria
| | - Irene Barrientos
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Daniela Kunkel
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Birgit M. Rami‐Merhar
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Edith Schober
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Andreas Karwautz
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Gudrun Wagner
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
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Sildorf SM, Breinegaard N, Lindkvist EB, Tolstrup JS, Boisen KA, Teilmann GK, Skovgaard AM, Svensson J. Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity. Diabetes Care 2018; 41:2289-2296. [PMID: 30270201 DOI: 10.2337/dc18-0609] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/26/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is associated with an increased risk of psychiatric morbidities. We investigated predictors and diabetes outcomes in a pediatric population with and without psychiatric comorbidities. RESEARCH DESIGN AND METHODS Data from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) and National Patient Register were collected (1996-2015) for this population-based study. We used Kaplan-Meier plots to investigate whether age at type 1 diabetes onset and average glycated hemoglobin (HbA1c) levels during the first 2 years after onset of type 1 diabetes (excluding HbA1c at debut) were associated with the risk of being diagnosed with a psychiatric disorder. Mixed-effects linear and logistic regression models were used to analyze HbA1c, BMI, severe hypoglycemia (SH), or ketoacidosis as outcomes, with psychiatric comorbidities as explanatory factor. RESULTS Among 4,725 children and adolescents with type 1 diabetes identified in both registers, 1,035 were diagnosed with at least one psychiatric disorder. High average HbA1c levels during the first 2 years predicted higher risk of psychiatric diagnoses. Patients with psychiatric comorbidity had higher HbA1c levels (0.22% [95% CI 0.15; 0.29]; 2.40 mmol/mol [1.62; 3.18]; P < 0.001) and an increased risk of hospitalization with diabetic ketoacidosis (1.80 [1.18; 2.76]; P = 0.006). We found no associations with BMI or SH. CONCLUSIONS High average HbA1c levels during the first 2 years after onset of type 1 diabetes might indicate later psychiatric comorbidities. Psychiatric comorbidity in children and adolescents with type 1 diabetes increases the risk of poor metabolic outcomes. Early focus on the disease burden might improve outcomes.
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Affiliation(s)
- Stine M Sildorf
- Department of Pediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark
| | - Nina Breinegaard
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Emilie B Lindkvist
- Department of Pediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Grete K Teilmann
- Department of Pediatrics and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jannet Svensson
- Department of Pediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark .,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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