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Poovey K, Brown TA, Rancourt D. Further validation of the visceral sensitivity index: Psychometric properties and utility for predicting disordered eating in a diverse university sample. Eat Behav 2024; 55:101920. [PMID: 39226630 DOI: 10.1016/j.eatbeh.2024.101920] [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: 03/21/2024] [Revised: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
Gastrointestinal (GI) visceral sensitivity (i.e., anxiety/worry over GI sensations) may be a key maintaining factor for disordered eating; however, it is unknown whether GI visceral sensitivity predicts the range of disordered eating behaviors in nonclinical samples. The current preregistered study aimed to replicate previous construct validity findings of the Visceral Sensitivity Index (VSI; i.e., factor structure, convergent and discriminant validity) and examine its criterion-related validity for predicting a range of disordered eating attitudes and behaviors in a diverse undergraduate sample. A total of 591 university students were retained in the final analytic sample (53 % women; 23 % Hispanic [Any Race], 10 % Asian, 9 % Black) and completed the VSI, disordered eating, and additional validity measures. A confirmatory factor analysis tested the factor structure of the VSI, and correlations were used to examine convergent and discriminant validity. Hierarchical regressions and t-tests were used to examine criterion-related validity. Results replicated previous construct validity findings in a diverse undergraduate sample. Exploratory analyses supported invariance of the VSI across gender and the VSI discriminated between individuals at high- versus low-risk for an eating disorder and predicted a range of disordered eating attitudes (e.g., body dissatisfaction) and behaviors (e.g., restricting, binge eating, purging, compulsive exercise). GI-specific anxiety appears to be transdiagnostic across disordered eating behaviors and relevant across the spectrum of disordered eating severity. Future work may include developing transdiagnostic models of GI visceral sensitivity in disordered eating and investigating inclusion of the VSI in university screening efforts.
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Affiliation(s)
- Kendall Poovey
- Department of Psychology, University of South Florida, 4204 E Fowler Ave, Tampa, FL 33620, USA.
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, 4204 E Fowler Ave, Tampa, FL 33620, USA
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Wisting L, Haugvik S, Wennersberg AL, Hage TW, Stice E, Olmsted MP, Ghaderi A, Brunborg C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. A pilot study of a virtually delivered dissonance-based eating disorder prevention program for young women with type 1 diabetes: within-subject changes over 6-month follow-up. Eat Disord 2024; 32:686-702. [PMID: 38511886 DOI: 10.1080/10640266.2024.2331391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
INTRODUCTION In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. METHODS Young women with T1D aged 16-35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. RESULTS Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen's ds ranged from .34 to 1.70). CONCLUSION The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
| | - Severina Haugvik
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetes Centre, Oslo, Norway
| | - Anne Louise Wennersberg
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Wiig Hage
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Eric Stice
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, USA
| | - Marion P Olmsted
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Cathrine Brunborg
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetes Centre, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetes Centre, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Oslo, Norway
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Dean YE, Motawea KR, Aslam M, Pintado JJL, Popoola‐Samuel HAO, Salam M, Dundi POR, Donaldy W, Aledani EM, Alqiqie Z, Sultana N, Mohamed ARH, Elalem A, Syeda STH, Mohamed MS, Assal MW, Attia NM, Hagar H, Abdelaziz HA, Subedi A, Elbahaie A, Hazimeh Y, Aiash H. Association Between Type 1 Diabetes Mellitus and Eating Disorders: A Systematic Review and Meta-Analysis. Endocrinol Diabetes Metab 2024; 7:e473. [PMID: 38597269 PMCID: PMC11005101 DOI: 10.1002/edm2.473] [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: 11/13/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Previous meta-analyses have shown mixed results regarding the association between eating disorders (EDs) and type 1 diabetes mellitus (T1DM). Our paper aimed to analyse different EDs and disordered eating behaviours that may be practiced by patients with T1DM. METHODS A literature search of PubMed, Scopus and Web of Science was conducted on 17 January 2023, using the key terms "T1DM," "Eating Disorders" and "Bulimia." Only observational controlled studies were included. The Revman software (version 5.4) was used for the analysis. RESULTS T1DM was associated with increased risk of ED compared with nondiabetic individuals (RR = 2.47, 95% CI = 1.84-3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18-6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18-1.98, p-value = 0.001). Our analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91-4.12, p-value < 0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27-3.23, p-value = 0.003). Prevalence of insulin omission/misuse was 10.3%; diabetic females demonstrated a significantly higher risk of insulin omission and insulin misuse than diabetic males. CONCLUSION Our study establishes a significant and clear connection between EDs and T1DM, particularly bulimia and binge eating, with T1DM. Moreover, female diabetics are at higher risk of insulin misuse/omission. Early proactive screening is essential and tailored; comprehensive interventions combining diabetes and ED components are recommended for this population, with referral to a specialised psychiatrist.
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Affiliation(s)
- Yomna E. Dean
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | - Muaaz Aslam
- Shaikh Khalifa Bin Zayed Al‐Nahyan Medical and Dental CollegeLahorePakistan
| | | | | | | | | | | | | | | | | | | | - Amir Elalem
- Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | | | | | | | - Hanan Hagar
- Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | | | - Anuj Subedi
- Prithvi Narayan Community HospitalGorkhaNepal
| | | | | | - Hani Aiash
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
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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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Rometsch C, Guthoff M, Zipfel S, Stengel A. Renal failure following insulin purging in atypical anorexia nervosa and type 1 diabetes mellitus. Front Psychiatry 2023; 14:1325021. [PMID: 38152359 PMCID: PMC10752605 DOI: 10.3389/fpsyt.2023.1325021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are severe and complex eating disorders that can be prevalent among individuals with type 1 diabetes mellitus (T1DM). Insulin purging, characterized by the intentional underuse / omission of insulin to control weight, is under-recognized in medicine and is a purging strategy of patients with AN or AAN and comorbid T1DM. Often, this can lead to renal failure, necessitating a (pancreas-) kidney transplantation. This article presents a comprehensive overview of the interplay between AN/AAN and T1DM and summarizes the evidence in literature. Methods A narrative review is presented on basis of a detailed case study of a 32-year-old female with end-stage renal failure seeking (pancreas-) kidney transplantation displaying etiology, diagnosis, comorbidities, complications, and treatment of AN and AAN with emphasis on those patients with T1DM. Results Insulin purging in patients with AN/AAN and coexisting T1DM can exacerbate T1DM complications, including accelerating the onset of end-stage renal failure. A multidisciplinary approach including nutrition treatment and psychotherapeutic techniques was considered necessary for treatment, focusing on psychosomatic in-patient care before and after organ transplantation. Conclusion Insulin purging in patients with AAN and T1DM poses severe health risks, including accelerated renal complications. For those considering transplantation, insulin purging has explicitly to be diagnosed and a holistic treatment addressing both the renal condition and psychosomatic symptoms/disorders is crucial for successful post-transplant outcomes.
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Affiliation(s)
- Caroline Rometsch
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Diabetology, Endocrinology, Nephrology, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Dziewa M, Bańka B, Herbet M, Piątkowska-Chmiel I. Eating Disorders and Diabetes: Facing the Dual Challenge. Nutrients 2023; 15:3955. [PMID: 37764739 PMCID: PMC10538145 DOI: 10.3390/nu15183955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Eating disorders and diabetes mellitus are distinct yet closely linked health conditions, presenting distinct challenges in terms of care and management. Eating disorders encompass a spectrum of mental health disorders characterized by abnormal eating behaviors and disruptions in weight regulation. Research indicates that individuals with diabetes might be at an elevated risk of developing eating disorders. The necessity to adhere to specific dietary guidelines, monitor blood sugar levels vigilantly, and manage drug administration can collectively contribute to the emergence of detrimental attitudes toward food and body image. On the other hand, incorrect eating behaviors such as binge eating and purging can disrupt blood sugar control, significantly impacting the development and management of diabetes. This intricate relationship emphasizes the crucial necessity for a comprehensive understanding and specialized care to effectively address the dual challenges faced by individuals dealing with both diabetes and eating disorders. This paper represents the inaugural comprehensive review delving into the intricate connection between eating disorders and diabetes, thereby illuminating previously under-researched areas. The insights gleaned from this review may contribute to developing integrated interventions that aim to improve the overall well-being and quality of life for individuals grappling with the complexities of eating disorders and diabetes.
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Affiliation(s)
| | | | | | - Iwona Piątkowska-Chmiel
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8b Street, 20-090 Lublin, Poland
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Atik-Altınok Y, Eliuz-Tipici B, İdiz C, Özgür S, Ok AM, Karşıdağ K. Psychometric properties and factor structure of the diabetes eatıng problem survey- revised (DEPS-R) among adults with type 1 diabetes mellitus. Eat Weight Disord 2023; 28:71. [PMID: 37665472 PMCID: PMC10477092 DOI: 10.1007/s40519-023-01602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/25/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Although many studies on the Diabetes Eating Problem Survey-Revised (DEPS-R) in adolescents with type 1 diabetes mellitus (T1D), the number of studies validating this questionnaire in adults with T1D is limited. Therefore, this study aimed to examine the factor structure of the Turkish version of the DEPS-R in adults with T1D and internal consistency and construct validity. METHODS A total of 100 patients with T1D, ages 18-50 years, completed the DEPS-R and EDE-Q. In addition to tests of validity, confirmatory factor analysis was conducted to investigate the factor structure of the 6-item Turkish version of DEPS-R. RESULTS The Cronbach's alpha coefficient of the DEPS-R Turkish version was 0.77, suggesting good internal consistency. The median (IQ) DEPS-R score was 15.0 (13.0) among all participants. DEPS-R score was significantly correlated with BMI (r = 0.210; p < 0.05) and EDE-Q (r = 0.586; p < 0.01). There was no correlation between the HbA1c values of participants and neither EDE-Q nor DEPS-R scores. The confirmatory factor analysis results show that the three-factor model was a good fit. CONCLUSION A short, self-administered diabetes-specific screening tool for disordered eating behavior is recommended be used routinely in the clinical care of adults with T1D, and Turkish version of DEPS-R has acceptable internal consistency and construct validity in adults with T1D. LEVEL OF EVIDENCE Level V, descriptive study. CLINICALTRIALS gov registration number NCT05346679/ 21.04.2022 (retrospectively registered).
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Affiliation(s)
- Yasemin Atik-Altınok
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Ege University, 35100, Bornova, İzmir, Turkey.
| | - Beyza Eliuz-Tipici
- Division of Pediatric Endocrinology, Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cemile İdiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Su Özgür
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ayşe Merve Ok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kubilay Karşıdağ
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Goddard G, Oxlad M, Turnbull D. The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review. J Diabetes Metab Disord 2023; 22:13-34. [PMID: 37255778 PMCID: PMC10225459 DOI: 10.1007/s40200-022-01151-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
Background Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males' misuse of insulin for weight and/or shape control. Methods A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021. Results A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies). Conclusion Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01151-8.
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Affiliation(s)
- Georgia Goddard
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemason’s Centre for Men’s Health and Wellbeing, Adelaide, Australia
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Claudia C, Eleonora R, Laura P, Romina L, Campanino C, Valdo R, Edoardo M, Ilaria D, Rotella F. Orthorexia nervosa and type 1 diabetes: results of a cross-sectional study. Acta Diabetol 2023; 60:681-686. [PMID: 36806923 DOI: 10.1007/s00592-023-02044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
AIM Orthorexia nervosa (ON) is a condition characterized by an excessive importance attributed to the intake of healthy foods. This study was aimed at investigating the prevalence of ON in subjects with type 1 diabetes (T1D) compared to control subjects. METHODS Patient with T1D using either flash glucose monitoring or continuous glucose monitoring were enrolled. For the selection of control group, each patient was asked to indicate one non-diabetic subject of their same sex and approximate age among colleagues at work and school. Patients and controls completed the following questionnaires: ORTO-15, Dusseldorf Orthorexie Scale (DOS), Eating Disorder Examination Questionnaire (EDE-Q) and Brief Symptom Inventory (BSI). The principal outcome was the prevalence of ON among T1D and control subjects. RESULTS We enrolled 44 patients with T1D aged 39.7 ± 15.7 years, with BMI 24.3 ± 4.3 kg/m2, and mean HbA1c 53.5 [49-57] mmol/mol. Control subjects were similar to T1D with respect to sex, age and BMI. Thirty-two [72%] and 29 [65%] subjects among patients and controls, respectively, had ORTO15 < 40 (between-group p = 0.48). Two (4.5%) and zero subjects among patients and controls, respectively, had DOS ≥ 30 (p = 0.29). Median scores of DOS, but not of ORTO-15, were significantly higher in patients than in controls. None of the metabolic variables showed a correlation with psychometric tests in T1D. CONCLUSION Although the prevalence of ON was not significantly higher in T1D than in controls, patients with T1D showed higher scores of some, but not all, tests assessing orthorexia, without any significant correlation with metabolic parameters.
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Affiliation(s)
| | - Rossi Eleonora
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pala Laura
- Department of Diabetology, Careggi Hospital, Florence, Italy
| | - Lelmi Romina
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
| | - Chiara Campanino
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Ricca Valdo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Mannucci Edoardo
- Department of Diabetology, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
| | - Dicembrini Ilaria
- Department of Diabetology, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
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Harray AJ, Roberts AG, Crosby NE, Shoneye C, Bebbington K. Experiences and Attitudes of Parents Reducing Carbohydrate Intake in the Management of Their Child’s Type 1 Diabetes: A Qualitative Study. Nutrients 2023; 15:nu15071666. [PMID: 37049506 PMCID: PMC10096792 DOI: 10.3390/nu15071666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
Reducing carbohydrate (CHO) intake is being used as an approach to manage type 1 diabetes (T1D) in children. This study aimed to investigate the experiences and attitudes of parents of children with T1D who are reducing CHO intake to help manage blood glucose levels (BGLs). Semi-structured interviews were conducted with the parents of children with T1D for >1 year who reported implementing a low CHO approach to manage BGLs. Data were analysed using a constant comparative analysis approach. Participants (n = 14) were parents of children (6.6 ± 2.0 years) with T1D in Western Australia. All parents reported different methods of CHO restriction and all perceived that benefits outweighed challenges. Parents reported feeling less worried, had improved sleep and felt their child was safer when using a low CHO approach due to more stable BGLs. Reported challenges included: increased cost and time spent preparing food; perceived judgement from others; and child dissatisfaction with restricted food choices. Parents reported accessing information and support through social media networks. Parents reported a desire for more research into this approach. Understanding the promoters and barriers for this dietary approach may inform strategies to better engage and support families with approaches that align with current evidence while considering their concerns around safety and hyperglycaemia.
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Affiliation(s)
- Amelia J. Harray
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Medical School, The University of Western Australia, Perth, WA 6009, Australia
- School of Population Health, Curtin University, Perth, WA 6102, Australia
- Correspondence: ; Tel.: +61-8-6456-5882
| | - Alison G. Roberts
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Naomi E. Crosby
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Charlene Shoneye
- School of Population Health, Curtin University, Perth, WA 6102, Australia
| | - Keely Bebbington
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Centre for Child Health Research, University of Western Australia, Perth, WA 6009, Australia
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Abild CB, Jensen AL, Lassen RB, Vestergaard ET, Bruun JM, Kristensen K, Støving RK, Clausen L. Patients' perspectives on screening for disordered eating among adolescents with type 1 diabetes. Eat Weight Disord 2023; 28:4. [PMID: 36754894 PMCID: PMC9908670 DOI: 10.1007/s40519-023-01539-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/29/2022] [Indexed: 02/10/2023] Open
Abstract
PURPOSE People with type 1 diabetes have an increased risk of disordered eating (DE) and eating disorders (ED). Screening is recommended however little is known about patients' perspectives on screening questionnaires. This paper reports qualitative analyses of patients' perspectives on the questionnaire Diabetes Eating Problem Survey Revised (DEPS-R), including acceptability, attitudes, and cognitive understanding. RESEARCH DESIGN AND METHODS 15 adolescents with type 1 diabetes between 11 and 18 years, were interviewed. A semi-structured format and a qualitative Interpretive Descriptive (ID) methodology was chosen. RESULTS The analyses identified four themes: (1) The Questionnaire, (2) Reframing Diabetes Visits, (3) This is (not) for me, and (4) Out in the Open. The DEPS-R was completed with-in 5-10 min. with no technical difficulties. The questionnaire altered the diabetes visit for some, creating a new dialog, and time for self-reflection. Adolescents appreciated the direct approach in the questionnaire, and showed willingness to complete the questionnaire, when presented to them by a health care professional (HCP). One item in the DEPS-R proved difficult to understand for some participants. CONCLUSION The study highlights DEPS-R as a clinically relevant screening questionnaire. Completing DEPS-R prior to a consultation opens the door to a consultation that invites the adolescent to address matters of eating behavior. Our findings suggest that systematic screening of DE/ED using the DEPS-R is both accepted and welcomed by adolescents with type 1 diabetes. Future research should focus on a potential update of selected items in DEPS-R. LEVEL OF EVIDENCE V - qualitative study.
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Affiliation(s)
- Caroline Bruun Abild
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Danish National Center for Obesity, Copenhagen, Denmark.
| | - Annesofie Lunde Jensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Pediatric Clinic, Regional Hospital Randers, Randers, Denmark
| | - Jens Meldgaard Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish National Center for Obesity, Copenhagen, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Esbjerg, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry-Research unit, Aarhus University Hospital, Aarhus, Denmark
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12
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Igudesman D, Crandell J, Corbin KD, Zaharieva DP, Addala A, Thomas JM, Bulik CM, Pence BW, Pratley RE, Kosorok MR, Maahs DM, Carroll IM, Mayer-Davis EJ. Associations of disordered eating with the intestinal microbiota and short-chain fatty acids among young adults with type 1 diabetes. Nutr Metab Cardiovasc Dis 2023; 33:388-398. [PMID: 36586772 PMCID: PMC9925402 DOI: 10.1016/j.numecd.2022.11.017] [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: 04/11/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Disordered eating (DE) in type 1 diabetes (T1D) includes insulin restriction for weight loss with serious complications. Gut microbiota-derived short chain fatty acids (SCFA) may benefit host metabolism but are reduced in T1D. We evaluated the hypothesis that DE and insulin restriction were associated with reduced SCFA-producing gut microbes, SCFA, and intestinal microbial diversity in adults with T1D. METHODS AND RESULTS We collected stool samples at four timepoints in a hypothesis-generating gut microbiome pilot study ancillary to a weight management pilot in young adults with T1D. 16S ribosomal RNA gene sequencing measured the normalized abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry measured SCFA (total, acetate, butyrate, and propionate). The Diabetes Eating Problem Survey-Revised (DEPS-R) assessed DE and insulin restriction. Covariate-adjusted and Bonferroni-corrected generalized estimating equations modeled the associations. COVID-19 interrupted data collection, so models were repeated restricted to pre-COVID-19 data. Data were available for 45 participants at 109 visits, which included 42 participants at 65 visits pre-COVID-19. Participants reported restricting insulin "At least sometimes" at 53.3% of visits. Pre-COVID-19, each 5-point DEPS-R increase was associated with a -0.34 (95% CI -0.56, -0.13, p = 0.07) lower normalized abundance of genus Anaerostipes; and the normalized abundance of Lachnospira genus was -0.94 (95% CI -1.5, -0.42), p = 0.02 lower when insulin restriction was reported "At least sometimes" compared to "Rarely or Never". CONCLUSION DE and insulin restriction were associated with a reduced abundance of SCFA-producing gut microbes pre-COVID-19. Additional studies are needed to confirm these associations to inform microbiota-based therapies in T1D.
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Affiliation(s)
- Daria Igudesman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA; AdventHealth Translational Research Institute, Orlando, 32804, USA.
| | - Jamie Crandell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA
| | - Karen D Corbin
- AdventHealth Translational Research Institute, Orlando, 32804, USA
| | - Dessi P Zaharieva
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, 94304, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, 94304, USA
| | - Joan M Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA
| | - Cynthia M Bulik
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA
| | | | - Michael R Kosorok
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA
| | - David M Maahs
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, 94304, USA
| | - Ian M Carroll
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA
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13
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Benton M, Cleal B, Prina M, Baykoca J, Willaing I, Price H, Ismail K. Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis. Gen Hosp Psychiatry 2023; 80:1-16. [PMID: 36493531 DOI: 10.1016/j.genhosppsych.2022.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Type 1 diabetes is associated with increased prevalence of individual categories of mental disorders. We aimed to systematically synthesise the prevalence of all the different categories of mental disorders to estimate the overall burden of psychiatric morbidity in the type 1 diabetes population. METHOD The electronic database of OVID was searched, and retrieved papers were screened for eligibility by two independent reviewers. Data were extracted using a standardised data extraction form and the quality of included papers was assessed. Where possible, comparisons with control groups without type 1 diabetes were made. Prevalence data were synthesised into Diagnostic and Statistical Manual of Mental Disorders version 5 categories, a narrative data-synthesis, and a subsequent meta-analysis where possible was conducted for mental disorder categories. RESULTS Thirty-eight articles were included. Depressive, anxiety, and feeding and eating disorders were the most examined mental disorders. Studies utilising diagnostic interviews reported higher prevalence of mental disorders than in studies utilising clinical registers, with an up to 24-fold difference respectively. In studies with a control group, the prevalence for nearly every mental disorder were increased for the type 1 diabetes samples. CONCLUSIONS There appears to be a high prevalence of mental disorders and associated need among people with type 1 diabetes, although the quality of research needs to improve. SYSTEMATIC REVIEW REGISTRATION This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020221530).
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Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom
| | - Bryan Cleal
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Mathew Prina
- Social Epidemiology Research Group, King's College London, 18 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Jeni Baykoca
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Ingrid Willaing
- Steno Diabetes Center, Borgmester Ib Juuls Vej 83, 2730 Herlev, Copenhagen, Denmark
| | - Hermione Price
- Southern Health NHS Foundation Trust, Southampton, Tremona Rd, Southampton SO16 6YD, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
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14
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Emotional eating and disordered eating behaviors in children and adolescents with type 1 diabetes. Sci Rep 2022; 12:21854. [PMID: 36528643 PMCID: PMC9759523 DOI: 10.1038/s41598-022-26271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Disordered eating behaviors (DEB) are more common in adolescents with type 1 diabetes (T1D) than in peers without diabetes. Emotional eating is a risk factor for binge eating in children and adolescents in the general population and is associated with increased intake of high energy-dense foods rich in sugars and fats. The primary objective is to evaluate whether emotional eating is associated with the metabolic control (glycated hemoglobin, plasma lipids and uric acid) in children and adolescents with type 1 diabetes and whether subjects with DEB (DEPS-R ≥ 20) have higher emotional eating than those without DEB. The secondary objective is to evaluate whether emotional eating is associated with the different symptoms of DEB. Emotional eating is positively correlated with HbA1c, total and LDL cholesterol values in children and adolescents with T1D. Subjects with DEB have a higher emotional eating score than subjects without DEB. Disinhibition is the most common disordered eating behavior in children and adolescents with T1D and is associated with a higher emotional eating score. Early identification and treatment of emotional eating could be tools for preventing DEB in people with type 1 diabetes. A total of 212 adolescents with T1D completed two self-administered questionnaires: the Diabetes Eating Problem Survey-Revised (DEPS-R) and the Emotional Eating Scale for Children and Adolescents (EES-C). Demographic (age, sex, duration of the disease), anthropometric (weight, height, BMI, BMI-SDS), therapeutic (type of insulin therapy, daily insulin dose) and metabolic (HbA1c, total cholesterol, HDL, LDL, triglycerides, uric acid) data were taken from the patients' medical records. The presence of other autoimmune diseases was also recorded.
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15
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de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, Delamater AM, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes 2022; 23:1373-1389. [PMID: 36464988 PMCID: PMC10107478 DOI: 10.1111/pedi.13428] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, Netherlands
| | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda A DiMeglio
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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16
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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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17
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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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18
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Pinna F, Suprani F, Deiana V, Lai L, Manchia M, Paribello P, Somaini G, Diana E, Nicotra EF, Farci F, Ghiani M, Cau R, Tuveri M, Cossu E, Loy E, Crapanzano A, Grassi P, Loviselli A, Velluzzi F, Carpiniello B. Depression in Diabetic Patients: What Is the Link With Eating Disorders? Results of a Study in a Representative Sample of Patients With Type 1 Diabetes. Front Psychiatry 2022; 13:848031. [PMID: 35782445 PMCID: PMC9243395 DOI: 10.3389/fpsyt.2022.848031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Comorbidity between diabetes and depression, and diabetes and eating disorders (ED) conveys significant diagnostic, clinical and therapeutic implications. The present study was conducted on a sample of adult outpatients affected by Type 1 Diabetes (T1DM) to assess lifetime prevalence of ED; current prevalence of depression and Disturbed Eating Behaviors (DEB) and their impact on glycemic control. We hypothesized that patients with depression would have higher rates of lifetime ED and current DEB. We hypothesized a significant and independent association between DEB and the prevalence of depression. Materials and Methods The study was carried out using a cross-sectional design in a sample of 172 diabetic patients with T1DM aged from 17 to 55 years. Lifetime prevalence of ED according to DSM-5 criteria was assessed by means of the Module H modified of the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). The following questionnaires were used: Beck Depression Inventory-IA version (BDI-IA) and Diabetes Eating Problems Survey-Revised (DEPS-R), to assess respectively the current presence of depression and DEB. Socio-demographic, clinical, and laboratory data were also collected. Results High rates of depression (35.5%) and DEB (19.2%) were observed in our sample of 172 adult outpatients with T1DM. Lifetime history of ED was present in 20.9% of the sample and was more frequently diagnosed in patients with current depression (34.4% vs. 13.9%, p = 0.002). Higher levels of DEB at DEPS-R significantly increased the odds of depression (adjOR: 1.09; 95% CI: 1.03-1.15; p = 0.003). The presence of DEB was associated with poor glycemic control. On the other hand, no association was found between depression and metabolic compensation. Conclusion Adult patients with T1DM and depression should be screened for ED and DEB. Treating DEB could positively impact both mood and glycemic control in this population. Further studies should be carried out on a larger patient population using a longitudinal design and an accurate method of evaluation to explore the complex relationship between diabetes, depression, ED, and DEB. Future research should investigate treatment strategies for DEB in T1DM patients and their impact on both psychopathological and metabolic outcomes.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Valeria Deiana
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Lorena Lai
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Enrica Diana
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | | | - Fernando Farci
- Unit of Diabetology, Azienda Sanitaria Locale Cagliari, Quartu Sant’Elena, Italy
| | - Mariangela Ghiani
- Unit of Diabetology, Azienda Sanitaria Locale Cagliari, Quartu Sant’Elena, Italy
| | - Rossella Cau
- Unit of Diabetology, Azienda Sanitaria Locale Cagliari, Quartu Sant’Elena, Italy
| | - Marta Tuveri
- Endocrinology and Diabetes Unit, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Efisio Cossu
- Endocrinology and Diabetes Unit, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Elena Loy
- Endocrinology and Diabetes Unit, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, CA, United States
| | - Paola Grassi
- Department of Education, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Andrea Loviselli
- Endocrinology and Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fernanda Velluzzi
- Endocrinology and Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
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19
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Steinhausen H, Villumsen MD, Hørder K, Winkler LA, Bilenberg N, Støving RK. Increased risk of somatic diseases following anorexia nervosa in a controlled nationwide cohort study. Int J Eat Disord 2022; 55:754-762. [PMID: 35451527 PMCID: PMC9323483 DOI: 10.1002/eat.23718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/19/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the risk of somatic diseases in connection with anorexia nervosa (AN). METHOD This matched cohort study was based on Danish registries of all patients born 1961-2008 with a first-time diagnosis of AN in 1994-2018 at age 8-32 and matched controls without an eating disorder. For 13 somatic disease categories, time from inclusion date to time of first somatic diagnosis, accounting for censoring, was studied by use of time-stratified Cox models. RESULTS A total of 9985 AN patients born 1961-2008 and 49,351 controls were followed for a median (interquartile range) of 9.0 (4.4-15.7) years. During the first 2 years after entry there was a 60% higher hazard for any somatic disease among patients with AN than among controls, while the ratio from three to 11 years was reduced to 1.18. Regardless of age at diagnosis, the hazard among patients and controls were no different at approximately a decade after diagnosis of AN and the cumulative risk for patients for 12 of 13 disease categories was always higher or no less that for controls. For all disease categories, the hazard ratio (HR) was higher when close to entry. For most disease categories, age at diagnosis of AN did not modify the effect. DISCUSSION While around 90% of all individuals had any somatic disease at the end of follow-up, the cumulative incidence over time was higher for patients with AN than for controls. Large HRs were seen in the early years after diagnosis during which patients require extensive medical interventions. PUBLIC SIGNIFICANCE Based on Danish registries, a large sample of almost 10,000 patients with AN born 1961-2008 and almost 50,000 matched controls were followed for a median of 9 years. While around 90% of all individuals had any somatic disease at the end of follow-up, the cumulative incidence over time was higher for patients with AN than for controls.
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Affiliation(s)
- Hans‐Christoph Steinhausen
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern DenmarkUniversity of Southern DenmarkOdenseDenmark,Child and Adolescent Mental Health Centre, Capital Region PsychiatryCopenhagenDenmark,Department of Child and Adolescent PsychiatryPsychiatric University Hospital of ZurichZurichSwitzerland,Clinical Psychology and Epidemiology, Institute of PsychologyUniversity of BaselBaselSwitzerland
| | - Martin Dalgaard Villumsen
- Department of Epidemiology, Biostatistics, and Biodemography, Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Kirsten Hørder
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern DenmarkUniversity of Southern DenmarkOdenseDenmark
| | - Laura Al‐Dakhiel Winkler
- Center for Eating DisordersOdense University HospitalOdenseDenmark,Psychiatric Services in the Region of Southern DenmarkOdenseDenmark
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern DenmarkUniversity of Southern DenmarkOdenseDenmark
| | - René Klinkby Støving
- Center for Eating DisordersOdense University HospitalOdenseDenmark,Psychiatric Services in the Region of Southern DenmarkOdenseDenmark,Endocrine Research UnitOdense University HospitalOdenseDenmark
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Irwin A, Igudesman D, Crandell J, Kichler JC, Kahkoska AR, Burger K, Zaharieva DP, Addala A, Mayer-Davis EJ. Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change (FLEX) intervention trial. Pediatr Diabetes 2022; 23:516-526. [PMID: 35297136 PMCID: PMC9268578 DOI: 10.1111/pedi.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the relationship between mindfulness and glycemia among adolescents with type 1 diabetes (T1D) with suboptimal glycemia, and evaluate the potential mediation by ingestive behaviors, including disordered eating, and impulsivity. RESEARCH DESIGN AND METHODS We used linear mixed models for hemoglobin A1c (HbA1c) and linear regression for continuous glucose monitoring (CGM) to study the relationship of mindfulness [Child and Adolescent Mindfulness Measure (CAMM)] and glycemia in adolescents with T1D from the 18-month Flexible Lifestyles Empowering Change (FLEX) trial. We tested for mediation of the mindfulness-glycemia relationship by ingestive behaviors, including disordered eating (Diabetes Eating Problem Survey-Revised), restrained eating, and emotional eating (Dutch Eating Behavior Questionnaire); and impulsivity (total, attentional, and motor, Barrett Impulsiveness Scale). RESULTS At baseline, participants (n = 152) had a mean age of 14.9 ± 1.1 years and HbA1c of 9.4 ± 1.2% [79 ± 13 mmol/mol]. The majority of adolescents were non-Hispanic white (83.6%), 50.7% were female, and 73.0% used insulin pumps. From adjusted mixed models, a 5-point increase in mindfulness scores was associated with a -0.19% (95%CI -0.29, -0.08, p = 0.0006) reduction in HbA1c. We did not find statistically significant associations between mindfulness and CGM metrics. Mediation of the relationship between mindfulness and HbA1c by ingestive behaviors and impulsivity was not found to be statistically significant. CONCLUSIONS Among adolescents with T1D and suboptimal glycemia, increased mindfulness was associated with lower HbA1c levels. Future studies may consider mindfulness-based interventions as a component of treatment for improving glycemia among adolescents with T1D, though more data are needed to assess feasibility and efficacy.
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Affiliation(s)
- Ashley Irwin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie Crandell
- Department of Biostatistics and School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dessi P Zaharieva
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, California, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, California, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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21
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Gürkan KP, Ayar D, Karadağ G, Böber E, Demir K. The effect of leisure boredom and A1C level on diabetes eating problems in adolescents with type 1 diabetes. J Pediatr Nurs 2022; 64:e1-e5. [PMID: 35184939 DOI: 10.1016/j.pedn.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Eating out of boredom, the changes in daily routine, physical inactivity and longer exposure to screens have made glycemic control difficult at home during the COVID-19 pandemic among adolescents with Type 1 Diabetes Mellitus. Adolescents with diabetes are at higher risk of developing eating problems than are their healthy peers. The aim of this study is to examine the effects of leisure time boredom and A1C level on eating problems in adolescents with Type 1 Diabetes Mellitus. DESIGN AND METHODS A descriptive, correlational, and cross-sectional design was used in this study. The study was conducted in Turkey, with the participation of 173 adolescents diagnosed with Type 1 Diabetes Mellitus. Convenience sampling was used to recruit patients from pediatric endocrinology outpatient clinics of hospitals. RESULTS It was determined that the diabetes eating problems of adolescents with Type 1 Diabetes were mostly affected by the level of leisure time and A1C, respectively. In the overall model, 58% (F = 4119.701, p < .001) of the factors affecting diabetes eating problems could be explained by the level of leisure boredom and A1C level. CONCLUSION It has been found that the adolescents with diabetes with high A1C levels and who cannot use their leisure time and have boredom are more at risk in terms of diabetes eating problems. PRACTICE IMPLICATIONS It should be determined how the adolescents with diabetes spend their lesiure time by diabetes health care team, which should be supported to develop leisure time skills. Effective use of leisure time and strategies to cope with boredom should also be included in diabetes education.
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Affiliation(s)
- Kübra Pınar Gürkan
- Dokuz Eylül University, Faculty of Nursing, Public Health Nursing Department, İnciraltı, Izmir, Turkey.
| | - Dijle Ayar
- Alanya Allaaddin Keykubat University, Faculty of Health Sciences, alanya, Turkey
| | - Gülendam Karadağ
- Dokuz Eylül University, Faculty of Nursing, Public Health Nursing Department, İnciraltı, Izmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medıcıne, Internal Medıcıne Department of Pedıatrıcs Pedıatrıc Endokrınology, İnciraltı, Izmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medıcıne, Internal Medıcıne Department of Pedıatrıcs Pedıatrıc Endokrınology, İnciraltı, Izmir, Turkey
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22
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Taras MA, Pellegrini A. Sex/Gender Psychological Differences in the Adult Diabetic Patient and How a Child’s Response to Chronic Disease Varies with Age and Can Be Influenced by Technology. DIABETOLOGY 2021; 2:215-225. [DOI: 10.3390/diabetology2040019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Chronic diseases have a negative impact on quality of life and perceived well-being. Depression tends to be more frequent in people with chronic diseases than the general population, and, for example, in diabetes, it has an incidence of two to three times higher and often remains under-diagnosed. The inability to control and predict the course of the disease exposes chronic patients to mood fluctuations which are often difficult to manage, also in virtue of the fact that in any chronic pathology a stabilization aimed at attenuating the symptoms or slowing the course is pursued, but it cannot tend to achieve complete healing. This fact of incurability for many subjects means the loss of control over their own body, in which the social and family role is also perceived as compromised and the experienced distress can result in the appearance of underlying disorders, both psychological or psychiatric. In this area, there is currently a great deal of focus on sex/gender differences. The aim of this article is to highlight these differences with regard to the emotional aspects that most affect the management of diabetic pathology. In this paper, we will underline a particularly underestimated eating disorder: diabulimia, then that the perception of itself is not only related to the sex assigned at birth, but also to the gender that is acquired during life, and we will also analyze the three phases related to the acquisition of gender identity during the evolutionary period. Finally, we will talk about the use of technology in diabetic patients (insulin pumps, continuous glucose monitoring variably integrated into each other) that might generate a series of psychological–behavioral reactions related to the integration between technology and body image and the experience of social acceptance of the individual, particularly in the evolution age.
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23
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Grammatikopoulou MG, Gkiouras K, Polychronidou G, Kaparounaki C, Gkouskou KK, Magkos F, Donini LM, Eliopoulos AG, Goulis DG. Obsessed with Healthy Eating: A Systematic Review of Observational Studies Assessing Orthorexia Nervosa in Patients with Diabetes Mellitus. Nutrients 2021; 13:3823. [PMID: 34836080 PMCID: PMC8622186 DOI: 10.3390/nu13113823] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 12/12/2022] Open
Abstract
Orthorexia nervosa (ON) is an unspecified feeding or eating disorder (USFED) characterized by an exaggerated, unhealthy obsession with healthy eating. Τypical eating disorders (EDs) and USFEDs are common among patients with diabetes mellitus (DM), which complicates metabolic control and disease outcomes. The present systematic review summarizes the evidence on the prevalence of ON symptomatology among patients with DM. PubMed, Web of Science, Scopus, and grey literature were searched, and relevant observational studies were screened using the Rayyan software. The quality of the studies was assessed using the appraisal tool for cross-sectional studies (AXIS) and the Newcastle-Ottawa scale (NOS). Out of 4642 studies, 6 fulfilled the predefined criteria and were included in the qualitative synthesis. Most studies relied on the ORTO-15 or its adaptations to identify ON among patients with DM. No apparent sex or age differences exist regarding the prevalence of ON symptoms. None of the studies compared the prevalence of ON in patients with type 1 and type 2 DM. Most of the research was of average to good methodological quality. In conclusion, patients with DM often exhibit ON tendencies, although research is still limited regarding the etiology or mechanistic drivers behind ON and the characteristics of patients with a dual ON-DM diagnosis.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, GR-57400 Thessaloniki, Greece;
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, University Campus, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (K.G.); (G.P.); (C.K.)
| | - Georgia Polychronidou
- Medical School, Faculty of Health Sciences, University Campus, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (K.G.); (G.P.); (C.K.)
| | - Chrysi Kaparounaki
- Medical School, Faculty of Health Sciences, University Campus, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (K.G.); (G.P.); (C.K.)
| | - Kalliopi K. Gkouskou
- Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece; (K.K.G.); (A.G.E.)
- Embiodiagnostics Biology Research Company, GR-71305 Heraklion, Greece
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg, Denmark;
| | - Lorenzo Maria Donini
- Department of Experimental Medicine-Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome, 00185 Rome, Italy;
| | - Aristides G. Eliopoulos
- Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece; (K.K.G.); (A.G.E.)
- Biomedical Research Foundation of the Academy of Athens, GR-11527 Athens, Greece
- Center for New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, GR-11527 Athens, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
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24
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Clever SN, Baulig S, Benecke A. Psychologische Herausforderungen bei Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1338-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungMenschen mit Typ-1-Diabetes müssen immer wieder verschiedene Anpassungsleistungen erbringen, um ihre Erkrankung und deren Therapie in den Alltag integrieren zu können. Gelingt dies nicht, können daraus Probleme beim Selbstmanagement der Krankheit resultieren. Doch trotz strukturierter Schulungsprogramme und leitliniengerechter, individuell zugeschnittener Therapieempfehlungen leben einige Menschen mit Typ-1-Diabetes mit chronisch erhöhten Blutzuckerwerten. Dabei scheint der Diabetes-Distress als Reaktion auf die erlebten Herausforderungen eine wichtige Rolle zu spielen und im Zusammenhang mit Problemen bei der glykämischen Kontrolle wie auch einer Therapievermeidung zu stehen. Um eine Chronifizierung des Diabetes-Distress zu verhindern, empfiehlt es sich daher, ein Screening auf diabetesbezogene Belastungen in der Versorgung von Menschen mit Typ-1-Diabetes zu etablieren. Dies kann mittels Fragebogen oder der Thematisierung im persönlichen Gespräch geschehen. Diabetesspezifische psychologische Interventionen können sowohl die diabetesbezogene emotionale Belastung als auch die glykämische Kontrolle verbessern, sind jedoch in Deutschland noch nicht in der Regelversorgung verfügbar.
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Affiliation(s)
- Susan Norah Clever
- Psychotherapiepraxis, Diabetespraxis Blankenese, Hamburg, Germany
- CEO, Medical Psychology Consultancy, Hamburg, Germany
| | - Susanne Baulig
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
| | - Andrea Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
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25
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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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26
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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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27
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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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28
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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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29
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Oldham-Cooper R, Semple C, Wilkinson LL. Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes. Clin Child Psychol Psychiatry 2021; 26:669-681. [PMID: 33601940 DOI: 10.1177/1359104520986215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach).
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
| | - Laura L Wilkinson
- Department of Psychology, College of Human & Health Sciences, Swansea University, Singleton Park, UK
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30
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Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems. J Clin Psychol Med Settings 2021; 27:727-745. [PMID: 31587133 DOI: 10.1007/s10880-019-09665-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ2 = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.
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31
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Instrument Context Relevance Evaluation, Translation, and Psychometric Testing of the Diabetes Eating Problem Survey-Revised (DEPS-R) among People with Type 1 Diabetes in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073450. [PMID: 33810376 PMCID: PMC8037186 DOI: 10.3390/ijerph18073450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
Background: People with type 1 diabetes are susceptible to disordered eating behaviors. The American Diabetes Association recommends using the Diabetes Eating Problem Survey-Revised (DEPS-R) to screen them. There is no validated diabetes-specific screening measure in China. The objectives were to adapt DEPS-R into Mandarin Chinese and to test its psychometric properties among youths and adults with type 1 diabetes in China, respectively. Methods: This study was conducted in two phases. Phase 1 included context relevance evaluation and instrument translation. Phase 2 was psychometric testing of reliability and construct validity among 89 youths (8~17 years old) and 61 adults with type 1 diabetes. Result: The Context Relevance Index and Translation Validity Index of this instrument were good. Strong internal consistency reliability correlations and convergent validity were demonstrated among youths and adults. Discussion: The Chinese version of the DEPS-R is a valid and reliable tool for screening disordered eating behaviors in Chinese youths and adults with type 1 diabetes. The Context Relevance Index is advocated to evaluate the difference between the context in which an instrument was originally developed and the target context.
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32
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Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis. Diagnostics (Basel) 2020; 10:diagnostics10121044. [PMID: 33287458 PMCID: PMC7761849 DOI: 10.3390/diagnostics10121044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Disordered eating behaviors (DEBs), including diagnosable eating disorders, are quite common and can interfere with optimal type 1 diabetes (T1DM) management. We explored DEBs prevalence in youth with T1DM, proposing news diagnostic subscales, to represent the clinical dimensions associated with feeding and eating disorders (ED); Methods: additionally to SCOFF questionnaire and Diabetes Eating Problem Survey–Revised (DEPS-R), four subscales combined from the original DEPS-R questionnaire were administered to 40 youths with T1DM (15.0 ± 2.6); Results: females showed higher scores than males in DEPS-R original factor 2 (“preoccupations with thinness/weight”, p = 0.024) and in DEPS-R proposed “restriction” factor (p = 0.009). SCOFF scores was correlated with original DEPS-R factors 1 (“maladaptive eating habits”) and 2 (p < 0.001) and with the newly proposed DEPS-R factors: restriction, disinhibition, compensatory behaviors, diabetes management (all p < 0.02). Diabetes management was the only factor related to glycated hemoglobin level (p = 0.006). Patients with high DEPS-R score (≥20) scored higher than patients with low (<20) DEPS-R score in DEPS-R original factors 1 (p < 0.001) and 2 (p = 0.002) as well as in the proposed factors including restriction, disinhibition, diabetes management (all p < 0.02); Conclusions: the complicated nature of DEBs calls for the development target specific questionnaires to be used as screening tools to detect cases of DEBs and exclude non cases. Early recognition of DEBs in adolescents with T1DM is essential for effective prevention and successful treatment.
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33
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Wisting L, Siegwarth C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. The impact of psychological aspects, age, and BMI on eating disorder psychopathology among adult males and females with type 1 diabetes. Health Psychol Open 2020; 7:2055102920975969. [PMID: 33282331 PMCID: PMC7691919 DOI: 10.1177/2055102920975969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study investigated correlates of eating disorder (ED) psychopathology among
adults with type 1 diabetes (T1D). A total of 282 males (n =
112) and females (n = 170) with T1D (18–79 years) participated.
Overall, psychological aspects (i.e. illness perceptions, coping strategies,
insulin beliefs, anxiety, and depression) were associated with ED
psychopathology. Associations were generally stronger among females than males.
In a regression model, age, BMI, personal control, and anxiety explained 51% of
the variance in ED psychopathology among females, whereas BMI, personal control,
and anxiety explained 47% of the variance among males. Greater clinical
awareness of health psychological aspects may contribute to reduce the risk of
developing ED.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Cecilie Siegwarth
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, University of Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, University of Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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Abstract
PURPOSE OF REVIEW Eating disorders represent one of the most common psychiatric disorders in adolescents with type 1 diabetes mellitus (T1DM), with a prevalence twice as high as in individuals without diabetes. The increased risk for acute and long-term medical complications and a three-fold mortality rate with this dual condition makes it extremely important to screen adolescents for eating disorders as soon as possible. RECENT FINDINGS A number of 13 surveys in the last two years focussed on prevalence rates of disordered eating and associations with sociodemographic, eating disorder-specific and diabetes-related factors in this population. Variations in study design, sample size, age range, sex, instruments to assess eating disorders and outcome make comparisons difficult. Healthcare professionals report challenges in detecting and treating adolescents with this dual condition because of a lack of validated screening tools, guidelines, and integration across specialist care. Studies on psychological treatments for the comorbidity of eating disorders and T1DM are scarce, especially for adolescents. SUMMARY The development and evaluation of psychological treatments for adolescents with eating disorders and T1DM are urgently needed.
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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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Broadley MM, Zaremba N, Andrew B, Ismail K, Treasure J, White MJ, Stadler M. 25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt? Diabet Med 2020; 37:401-408. [PMID: 31797439 DOI: 10.1111/dme.14197] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Disordered eating is a serious and under-recognized problem in people with diabetes. This narrative review summarizes the research contributions made by psychological science over the past 25 years to the study of disordered eating in people with type 1 or type 2 diabetes, and identifies gaps and future directions relevant to both healthcare professionals and researchers. Key focus areas of psychological research investigating disordered eating in people with diabetes have been: (1) defining and classifying types of disordered eating; (2) identifying demographic, diabetes-specific and psychosocial correlates of disordered eating, and developing theoretical models of disordered eating in people with type 1 diabetes; (3) identifying the physical and psychosocial consequences of disordered eating; and (4) developing screening measures to identify disordered eating in people with type 1 diabetes. Psychological science has made significant contributions over the past 25 years to our understanding of the nature of this problem and the multiple factors which may interrelate with disordered eating in people with diabetes. Key areas for further attention include: (1) a better definition of disordered eating subtypes in people with type 1 diabetes; (2) characterizing disordered eating in people with type 2 diabetes; and (3) developing multidisciplinary, evidence-based prevention and treatment interventions for comorbid disordered eating and diabetes.
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MESH Headings
- Behavioral Research/history
- Behavioral Research/methods
- Behavioral Research/trends
- Biomedical Research/history
- Biomedical Research/methods
- Biomedical Research/trends
- Diabetes Complications/epidemiology
- Diabetes Complications/etiology
- Diabetes Complications/psychology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/psychology
- Feeding and Eating Disorders/complications
- Feeding and Eating Disorders/epidemiology
- Feeding and Eating Disorders/psychology
- History, 20th Century
- History, 21st Century
- Humans
- Psychology/history
- Psychology/methods
- Psychology/trends
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Affiliation(s)
- M M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - N Zaremba
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | - B Andrew
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - K Ismail
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, London, UK
| | - J Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M J White
- Queensland University of Technology School of Psychology and Counselling, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, Australia
| | - M Stadler
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
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Igudesman D, Sweeney M, Carroll IM, Mayer-Davis EJ, Bulik CM. Gut-Brain Interactions: Implications for a Role of the Gut Microbiota in the Treatment and Prognosis of Anorexia Nervosa and Comparison to Type I Diabetes. Gastroenterol Clin North Am 2019; 48:343-356. [PMID: 31383275 PMCID: PMC6686879 DOI: 10.1016/j.gtc.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Anorexia nervosa has poor prognosis and treatment outcomes and is influenced by genetic, metabolic, and psychological factors. Gut microbes interact with gut physiology to influence metabolism and neurobiology, although potential therapeutic benefits remain unknown. Type 1 diabetes is linked to anorexia nervosa through energy dysregulation, which in both disease states is related to the gut microbiota, disordered eating, and genetics.
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Affiliation(s)
- Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Megan Sweeney
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Ian M Carroll
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Cynthia M Bulik
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Luyckx K, Verschueren M, Palmeroni N, Goethals ER, Weets I, Claes L. Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study. Diabetes Care 2019; 42:1637-1644. [PMID: 31217162 DOI: 10.2337/dc19-0445] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Disturbed eating behavior (DEB) is prevalent in youth with type 1 diabetes and is accompanied by an increased risk for complications, morbidity, and mortality. Prospective studies on DEB in the challenging transition to adulthood are scarce. This longitudinal study examined DEB over a 1-year period and investigated the directionality of effects linking DEB to diabetes-specific functioning and depressive symptoms in adolescents and emerging adults. RESEARCH DESIGN AND METHODS Three hundred youth (16-28 years old) with type 1 diabetes participated in a two-wave longitudinal study. Questionnaires measured DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms. HbA1c values were obtained from physicians. Mixed ANOVA and cross-lagged analysis were used to examine prospective changes and directionality of effects, respectively. RESULTS Mean DEB remained stable in the total sample, but significant individual differences were observed based on the cutoff score of the DEPS-R: 19% displayed persistent DEB and 8% increased and 7.3% decreased in DEB over time. The remaining individuals scored low on DEB over time. These four groups were differentiated based on insulin restriction, omission, diabetes-specific functioning, and depressive symptoms. Cross-lagged analyses indicated that DEB predicted relative increases in depressive symptoms over time, whereas reciprocal associations with glycemic control were found. CONCLUSIONS This longitudinal study highlights the substantial impact DEB may have in the transition to adulthood, with a substantial portion of youth with type 1 diabetes being at risk for clinical DEB. Prospective pathways linking DEB to functioning were found, emphasizing the clinical relevance of assessing DEB over time.
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Affiliation(s)
- Koen Luyckx
- University of Leuven, Leuven, Belgium .,Unit for Professional Training and Service in the Behavioral Sciences, University of the Free State, Bloemfontein, South Africa
| | - Margaux Verschueren
- University of Leuven, Leuven, Belgium.,FWO Research Foundation Flanders, Brussels, Belgium
| | | | - Eveline R Goethals
- University of Leuven, Leuven, Belgium.,Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Ilse Weets
- Free University Brussels, Brussels, Belgium
| | - Laurence Claes
- University of Leuven, Leuven, Belgium.,University of Antwerp, Antwerp, Belgium
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39
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Ryman B, MacIsaac J, Robinson T, Miller MR, Herold Gallego P. Assessing the clinical utility of the diabetes eating problem survey-revised (DEPS-R) in adolescents with type 1 diabetes. Endocrinol Diabetes Metab 2019; 2:e00067. [PMID: 31294083 PMCID: PMC6613221 DOI: 10.1002/edm2.67] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Eating disorders are prevalent among adolescents with type 1 diabetes (T1D). We examined the clinical utility of the Diabetes Eating Problem Survey-Revised (DEPS-R), a brief self-report questionnaire developed for patients with T1D, to identify at-risk adolescents. We aimed to determine whether a positive DEPS-R screen was predictive of a formal diagnosis of an eating disorder as per the DSM-V. In addition, we assessed whether other variables including psychosocial characteristics and diabetes conflict were associated with an abnormal DEPS-R screen. METHODS Cross-sectional study of 116 T1D adolescents aged 12-17 years. All participants completed the DEPS-R screening; both participants and parents completed a questionnaire addressing psychosocial characteristics/conflict around diabetes management. Clinical variables were obtained from participant charts. Differences were examined between positive and negative DEPS-R groups. Adolescents who screened positive were offered a referral to a specialized eating disorder team for further assessment. RESULTS From 116 participants (mean age ± SD = 14.6 years ± 1.56), 21% (24/116) scored positive for DEPS-R More females than males had abnormal DEPS-R (75% vs 25%, P = 0.001). Those with positive DEPS-R score had higher HbA1c% (mean = 9.3 ± 1.3 vs 8.3 ± 1.2, P = 0.001). Positive DEPS-R group had higher conflict score for diabetes management in both parents' and children's assessments (both ps < 0.001). In regression analysis, being female (OR males = 0.07, 95%CI: 0.010-0.46, P = 0.006), older (OR = 2.01, 95%CI: 1.16-3.48, P = 0.040) and > child-reported conflict (OR = 1.78, 95%CI: 1.02-3.11, P = 0.044) were predictors of an abnormal DEPS-R score. CONCLUSION The DEPS-R score is a useful clinical tool for identifying T1D adolescents at risk for disordered eating behaviour, but has a low positive predictive value (PPV) for identifying adolescents who meet diagnostic criteria for an eating disorder. Female gender, suboptimal diabetes control and increased conflict in diabetes management are associated with an abnormal DEPS-R score.
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Affiliation(s)
- Brianna Ryman
- Department of PaediatricsWestern UniversityLondonOntarioCanada
| | - Jenna MacIsaac
- Department of PaediatricsWestern UniversityLondonOntarioCanada
| | - Tracy Robinson
- Department of PaediatricsWestern UniversityLondonOntarioCanada
| | - Michael R. Miller
- Department of PaediatricsWestern UniversityLondonOntarioCanada
- Children’s Health Research Institute, Children’s Hospital, London Health Sciences CentreLondonOntarioCanada
| | - Patricia Herold Gallego
- Department of PaediatricsWestern UniversityLondonOntarioCanada
- Pediatric Endocrinology SectionChildren’s Hospital, London Health Sciences Centre (LHSC)LondonOntarioCanada
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40
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Gallagher KAS, DeSalvo D, Gregory J, Hilliard ME. Medical and Psychological Considerations for Carbohydrate-Restricted Diets in Youth With Type 1 Diabetes. Curr Diab Rep 2019; 19:27. [PMID: 31030356 DOI: 10.1007/s11892-019-1153-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Given the challenges achieving recommended glycemic targets in youth with type 1 diabetes (T1D), providers may consider recommending carbohydrate-restricted diets (CRDs) to optimize glycemic control. The goal of the present review is to describe relevant literature on the potential medical and psychosocial benefits and risks of CRDs in youth with T1D. RECENT FINDINGS Limited data exist on the effects of CRDs in pediatric populations. Findings from studies with youth and adults are mixed; some indicate that CRDs may be associated with desirable medical outcomes, such as improved glycemic control and reduced HbA1c, which may contribute to positive psychological outcomes such as reduced diabetes distress and depressive symptoms. Others suggest that CRDs may also be associated with detrimental outcomes, including mineral deficiencies and suboptimal growth, and dietary restriction has been linked to greater diabetes distress, disordered eating, and diabetes management. More research is needed to evaluate benefits and risks of CRDs in youth. Providers should exercise caution when discussing CRDs with youth and families, particularly when considering CRDs for youth at elevated risk for eating disordered behavior.
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Affiliation(s)
- Katherine A S Gallagher
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX, 77030, USA
| | - Daniel DeSalvo
- Baylor College of Medicine and Texas Children's Hospital, 6701 Fannin Street, Suite 1020, Houston, TX, 77030, USA
| | - Justin Gregory
- Vanderbilt University School of Medicine, 1500 21st Ave, Suite 1514, Nashville, TN, 37212, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Ave, Suite 940, Houston, TX, 77030, USA.
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41
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Wisting L, Rø A, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control. J Health Psychol 2019; 26:688-700. [DOI: 10.1177/1359105319840688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Oslo Diabetes Research Centre, Norway
| | - Astrid Rø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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42
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Troncone A, Cascella C, Chianese A, Zanfardino A, Confetto S, Piscopo A, Iafusco D. Parental assessment of disordered eating behaviors in their children with type 1 diabetes: A controlled study. J Psychosom Res 2019; 119:20-25. [PMID: 30947813 DOI: 10.1016/j.jpsychores.2019.02.003] [Citation(s) in RCA: 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: 11/22/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this research is to examine the presence of disordered eating behaviors (DEBs) in youths with type 1 diabetes (T1D) according to their parents' evaluations. The roles of demographic and diabetes-related variables were also analyzed. METHODS In 54 patients with T1D (aged 10.07-15.08) and in 54 age- and gender-matched healthy controls, DEBs were assessed using a parent-report standardized measure. BMI was calculated from height and weight. Glycemic control was assessed based on the most recent glycosylated hemoglobin value (HbA1c). The association of demographic and clinical factors with DEBs was evaluated through correlation and linear regression analyses. RESULTS DEBs were observed more frequently in participants with T1D (33.3%) than in controls (11%) (χ2 = 6.501, p = .04). The clinical sample obtained a higher score than controls in PEBEQ total score (t(106) = 2.464, p = .01), as well as in the Exaggerated interest in food (t(106) = 2.723, p = .008) and Rejection/disinterest in food subscales (t(106) = 2.216, p = .01). No gender differences were observed. In participants with T1D, but not in controls, PEBEQ total score was positively correlated with age (r = 0.203, p = .04), HbA1c (r = 0.335, p = .01), and zBMI (r = 0.298, p = .002); HbA1c (standardized beta =0.284, p = .04) was found to uniquely predict the PEBEQ total score. CONCLUSION Parents' evaluations may contribute to prompt detection of DEBs, which is crucial in developing appropriate strategies for timely intervention, especially during adolescence.
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Abstract
Estimates of lifetime bulimia nervosa (BN) range from 4% to 6.7% across studies. There has been a decrease in the presentation of BN in primary care but an increase in disordered eating not meeting full diagnostic criteria. Regardless of diagnostic status, disordered eating is associated with long-term significant impairment to both physical and mental quality of life, and BN is associated with a significantly higher likelihood of self-harm, suicide, and death. Assessment should adopt a motivationally enhancing stance given the high level of ambivalence associated with BN. Cognitive behavior therapy specific to eating disorders outperforms other active psychological comparisons.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
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44
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Prom MC. Facing Diabetes: A Guide for Psychiatric Providers. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190104-01] [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: 11/20/2022]
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45
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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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Wisting L, Wonderlich J, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Psychometric properties and factor structure of the diabetes eating problem survey - revised (DEPS-R) among adult males and females with type 1 diabetes. J Eat Disord 2019; 7:2. [PMID: 30675355 PMCID: PMC6337821 DOI: 10.1186/s40337-018-0232-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although an increasing amount of research has now established good psychometric properties and a three-component factor structure of the Diabetes Eating Problem Survey - Revised (DEPS-R) in pediatric samples with type 1 diabetes (T1D), research using adult samples has been limited and divergent. This study therefore aimed to investigate psychometric properties and test a three-factor model of the DEPS-R among adults with T1D. METHODS A total of 282 adults with T1D aged 18-79 years participated in the study. Measures included the DEPS-R, the Eating Disorder Examination Questionnaire (EDE-Q), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. RESULTS The DEPS-R total mean score (SD) for the total sample, males, and females were 13.8 (9.2), 11.2 (7.8), and 15.6 (9.6) respectively. Good fit indices for the confirmatory factor analysis were found. The Cronbach's alpha of the DEPS-R was .84, suggesting good internal consistency. The DEPS-R correlated significantly with the EDE-Q among both males (.52, p < .01) and females (.68, p < .001). Also, the DEPS-R correlated significantly with BMI in both genders (.33, p < .001 in females and .35, p < .001 in males). HbA1c correlated significantly with the DEPS-R in females (.27, p < .01), but not in males. CONCLUSIONS Good fit for a three-factor structure of the DEPS-R was confirmed. Further, the DEPS-R demonstrated good psychometric properties among adults with T1D, and can be recommended for clinical use for this patient group.
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Affiliation(s)
- Line Wisting
- 1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Joseph Wonderlich
- 3Department of Psychology, George Mason University, Fairfax, VA 22030 USA
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,4Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,5Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway.,The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,4Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,5Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway.,The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Øyvind Rø
- 1Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.,7Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
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Wisting L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Prevalence of disturbed eating behavior and associated symptoms of anxiety and depression among adult males and females with type 1 diabetes. J Eat Disord 2018; 6:28. [PMID: 30214804 PMCID: PMC6131775 DOI: 10.1186/s40337-018-0209-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/27/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The increased prevalence of disturbed eating behaviors (DEB), depression, and anxiety in type 1 diabetes (T1D) is generally well established; however the majority of existing research to date has focused on female adolescents and young adults. Data on males and older females is scarce. The aim of this study was to assess prevalence of DEB and symptoms of depression and anxiety among adult males and females with type 1 diabetes, to investigate differences between individuals scoring below and above the cut-off on psychopathology, and to examine patterns of eating disorder psychopathology by age and weight. METHODS A total of 282 adults with type 1 diabetes aged 18-79 years participated in the study. Measures included the Diabetes Eating Problem Survey - Revised (DEPS-R), the Hospital Anxiety and Depression Scale (HADS), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. RESULTS A total of 20.3% of the whole sample (13.3% among males and 24.8% among females) scored above the DEPS-R cut-off score for DEB. As for depression and anxiety, the prevalence in the whole sample was 6.2% and 19.0%, respectively. The prevalence was generally higher in females than males across all psychopathology measures. HbA1c was significantly associated with the DEPS-R total score (p < .01) among females, but not with depression and anxiety. Mean DEPS-R score decreased with increasing age, and when our previous reported data from children and adolescents are included, a peak prevalence in DEB in adolescence and young adult age is demonstrated. CONCLUSIONS The results of this study point to the need for increased awareness of psychological comorbidity among adults with type 1 diabetes, in particular young adult females. Screening is recommended to secure early detection and subsequent intervention for these individuals.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
- The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
- The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
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Solmi F, Melamed D, Lewis G, Kirkbride JB. Longitudinal associations between psychotic experiences and disordered eating behaviours in adolescence: a UK population-based study. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:591-599. [PMID: 30119718 PMCID: PMC6054050 DOI: 10.1016/s2352-4642(18)30180-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Psychotic experiences might represent non-specific markers of poor mental health in adolescence. However, only a few predominantly cross-sectional studies have tested their association with disordered eating behaviours in adolescent and adult populations. The aim of this study was to explore the association between psychotic experiences at age 13 years, and disordered eating behaviours and body-mass index (BMI) at age 18 years. METHODS We used data from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort based in Avon (England, UK) including mothers with an expected delivery date between April 1, 1991, and Dec 31, 1992, and their children. Psychotic experiences (such as delusions and hallucinations) and BMI were measured at clinical assessments when children were nearly aged 13 years, and data on disordered eating behaviours (ie, presence of binge eating, purging, fasting, or excessive exercise for weight loss; any of these behaviours [included to increase statistical power]; and number of behaviours [included to investigate severity]) were obtained via a postal questionnaire that used adapted questions from the Youth Risk Behaviour Surveillance System questionnaire at approximately age 18 years. For each outcome, we ran a univariable model and four multivariable models (logistic, linear [for BMI], or negative binomial [for the number of behaviours] regression), progressively adjusting for child and maternal sociodemographic, physical, and mental health characteristics (including child's sex, and maternal age, marital status, and highest academic qualification); autistic traits at age 7 years (measured with the Social and Communication Disorder Checklist); baseline BMI at age 13 years, and depressive symptoms at baseline (ie, at age 13 years when psychotic experiences were measured: childs' symptoms measured with the Moods and feelings Questionnaire, and maternal symptoms measured at 32 weeks' gestation with the Edinburgh Postnatal Depression Scale). We imputed missing outcome and covariate data. FINDINGS Our sample included 6361 children, of whom 734 (12%) reported psychotic experiences at age 13 years. In univariable models, psychotic experiences were associated with greater odds of reporting any disordered eating behaviours (odds ratio [OR] 1·92, 95% CI 1·46-2·52; p<0·0001), and more severe symptoms (as measured by the number of disordered eating behaviours: 0·58, 0·32-0·84; p<0·0001) at age 18 years. These associations were slightly attenuated by adjustment for maternal and child characteristics (any disordered eating behaviours OR 1·82, 95% CI 1·35-2·44, p<0·0001; number of disordered eating behaviours 0·49, 95% CI 0·23-0·75, p<0·00001), autistic traits at age 7 years (any disordered eating behaviours OR 1·80, 95% CI 1·34-2·41, p<0·0001; number of disordered eating behaviours 0·48, 95% CI 0·22-0·74, p<0·00001), and BMI (any disordered-eating behaviours OR 1·83, 95% CI 1·36-2·46, p<0·0001; number of disordered-eating behaviours 0·32, 95% CI 0·06-0·57, p<0·00001) Adjusting for baseline depressive symptoms attenuated, but not removed, these associations (any disordered eating OR 1·50, 95% CI 1·10-2·03, p=0·010; more severe symptoms 0·32, 0·06-0·57, p=0·017). Psychotic experiences were also associated with greater binge eating, purging, and fasting behaviours, although some associations weakened after controlling for depressive symptoms. We noted no associations between psychotic experiences and excessive exercise or BMI in any of the models. INTERPRETATION Our findings suggested that psychotic experiences are markers of increased risk for several disordered eating behaviours in late adolescence, possibly by indicating more severe psychopathology in early adolescence. More research investigating shared risk factors for psychotic experiences and eating disorders is warranted to elucidate shared and specific causal pathways. FUNDING Wellcome Trust, the Royal Society, University College London Hospitals National Institute for Health Research Biomedical Research Centre, UK Medical Research Council, and the University of Bristol.
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Affiliation(s)
- Francesca Solmi
- Division of Psychiatry, University College London, London, UK.
| | - Daniela Melamed
- Division of Psychiatry, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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De Paoli T, Rogers PJ. Disordered eating and insulin restriction in type 1 diabetes: A systematic review and testable model. Eat Disord 2018; 26:343-360. [PMID: 29182474 DOI: 10.1080/10640266.2017.1405651] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To provide an overview of the existing literature pertaining to insulin restriction as a disordered eating behaviour in individuals with type 1 diabetes and present a novel maintenance model: The Transdiagnostic Model of Disordered Eating in Type 1 Diabetes. METHOD A systematic review was conducted of the current literature relevant to insulin restriction and/or omission in the context of disordered eating in type 1 diabetes. A new maintenance model was then developed by incorporating diabetes-specific factors into existing eating disorder models. RESULTS Type 1 diabetes may complicate the development and maintenance of disordered eating behaviour. Diabetes-specific circumstances, including disease diagnosis, insulin management, insulin restriction, and diabetes-related complications, contribute to the maintenance of disordered eating cognitions and behaviours. DISCUSSION The proposed model offers a comprehensive representation of insulin restriction as a disordered eating behaviour in type 1 diabetes. Future research should test the model to further understand the mechanisms underlying disordered eating in type 1 diabetes and inform treatments for this at-risk population.
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Affiliation(s)
- Tara De Paoli
- a Melbourne School of Psychological Sciences , The University of Melbourne , Melbourne , VIC , Australia
| | - Peter J Rogers
- b Nutrition and Behaviour Unit, School of Experimental Psychology , University of Bristol , Bristol , United Kingdom
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Tichonenko EV, Tsoi UA, Vasilieva EY, Babenko AY. Characteristics of eating behavior and the level of hormones regulating the appetite in patients with type 2 diabetes mellitus and body mass index more than 35 kg /m2. ACTA ACUST UNITED AC 2018. [DOI: 10.14341/omet2018130-38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. The role of the hormones in eating behavior in the regulation of appetite has been well studied, but their relationship with various types of eating behavior has not been established.
Aims. To study the frequency of different types of eating behavior, hunger/satiety feeling estimated by the visual analog scale and levels of leptin and gastrointestinal tract hormones that are involved in appetite regulation, fat and carbohydrate metabolism (ghrelin and glucagon-like peptide 1) in patients with diabetes mellitus type 2 and obesity.
Materials and methods. The study included 35 people with obesity (BMI35 kg/m2) and diabetes mellitus type 2 (T2DM) who received the stable sugar-lowering therapy, the median body mass index (BMI) was 40,1 [36,5; 49,6] kg/m2, the median age was 58 [52,5; 64] years. Blood tests for insulin, leptin, ghrelin, glucagon-like peptide-1, C-peptide, glucose, glycated hemoglobin and lipids profile were done in all cases, also HOMA-IR and HOMA- were calculated. All patients completed questionnaires determining eating behavior type and hunger/satiety feeling severity.
Results. In patients with T2DM and obesity a high frequency of combination of different types of eating behavior were found, it was 54,3%. Among the isolated types, restrictive eating behavior was more common in 40%. In patients with different types of eating behavior the tendency to difference in the level of hormones regulating appetite was found, but it was not significant. High frequency of an appropriate reduction of postprandial ghrelin level was found in patients with restrictive type of eating behavior. Correlation between the level of hormones regulating appetite and hunger/satiety feeling was weak, it might reflect the resistance to these hormones in patients with severe obesity and T2DM. At the same time the relationship between the ghrelin level and the -cells functional state parameters was significant.
Conclusions. The severity of leptin and ghrelin resistance correlated with each other in T2DM and obesity patients; the severity of ghrelin resistance was associated with the beta cells functional state; according to our data postprandial ghrelin level may have opposite changes in patients with T2DM and obesity and its adequate reduction is more common for patients with restrictive type of eating behavior.
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