Clinical Characteristics at T1D Diagnosis May Predict Disordered Eating Behaviors

Credit: Annie Spratt/unsplash

New research suggests disordered eating behaviors are common among adolescents with type 1 diabetes (T1D), with nearly one-third of the study cohort exhibiting scores indicating issues with eating behaviors.¹

Results indicate various clinical characteristics predicted the development of disordered eating behaviors, including body mass index (BMI) score at diagnosis and the rate of weight gain post-diagnosis in female patients.

“Our findings suggest that efforts to prevent disordered eating behaviors in adolescents with T1D should begin as early as possible after disease onset,” wrote the investigative team, led by Tamar Propper-Lewinsohn, from the institute for endocrinology and diabetes, national center for childhood diabetes at Schneider Children’s Medical Center of Israel. “Furthermore, as disordered eating behaviors are so prevalent in this population, routine screening, preventive measures, and early interventions are warranted.”

Childhood T1D diagnosis can be traumatic for both the child and family; at diagnosis, weight loss owing to the lack of insulin is usually followed by rapid weight gain after the initiation of insulin treatment. Undesired weight gain could later lead to the development of disordered eating behaviors and reduce adherence to insulin treatment.²

Ranging a spectrum of eating pathologies that do not meet a formal diagnosis, disordered eating behaviors can include binge eating, restricting food intake, rigid dietary rules, and purging to reduce body weight. In adolescents with T1D, disordered eating behaviors can include binge eating and purging followed by insulin restriction or omission. Together, the combination of the disease and disordered eating behaviors is associated with poor glycemic control, increased risk of short- and long-term complications, and risk of death.

For the current analysis, Propper-Lewinsohn and colleagues looked to assess the prevalence of disordered eating behaviors and disease-related risk factors for their development in adolescents with T1D. The team additionally sought risk factors at disease diagnosis that may predict the development of disordered eating behaviors. To do so, they conducted an observational, retrospective study of adolescents aged 15 - 19 years with T1D treated at the study center’s diabetes clinic.

Each study participant completed the Diabetes Eating Problem Survey-Revised (DEPS-R) to be screened for disordered eating behaviors. The DEPS-R is a 16-item diabetes-specific self-reporting screening tool for disordered eating with scores ranging from 0 to 80 points; it includes different features on disordered eating behaviors, including a drive for thinness, eating pathologies, and diabetes management. A score of ≥ 20 suggests an increased risk for disordered eating behaviors.

The investigative team collected clinical data, including age, sex, anthropometric measurements, diabetes duration, hemoglobin A1c, insulin regimen, use of continuous glucose monitoring (CGM), and comorbidity with Celiac disease, on study participants from medical records at the end of the DEPS-R survey. A total of 297 adolescents completed the DEPS-R questionnaire and after exclusions, 291 adolescents (45.4%) were included in the analysis. Of this population, 84 participants (28.9%) scored above the threshold of ≥20, suggesting a high risk for disordered eating behaviors.

Upon analysis, disordered eating behaviors were positively associated with BMI-z score (r = .24; P <.001) and HbA1c (r = .39; P <.001). Linear regression analysis of variables associated with DEPS-R score showed that female sex (β, 3.01; P = .002), higher BMI z-score (β, 2.08; P <.001), higher HbA1c (β, 0.19; P <.001), and multiple daily injections of insulin (β, 2.19; P = .032).

Multivariate linear regression for children diagnosed at younger than 13 years identified a higher BMI Z-score as the only significant predictor for a higher DEPS-R score (β, 1.54; P = .016). For those children diagnosed at 13 years or older, the only significant predictor for a higher DEPS-R score was increased weight gain at 3 months post-diagnosis in females (β, 0.88; P = .001).

“These findings suggest that various clinical characteristics, including age at diagnosis and disease duration, affect the development of disordered eating behaviors,” investigators wrote. “Thus, it is essential to define the risk factors for developing disordered eating behaviors in adolescents with T1D.”

References

1. Propper-Lewinsohn T, Gillon-Keren M, Shalitin S, et al. Disordered eating behaviours in adolescents with type 1 diabetes can be influenced by their weight at diagnosis and rapid weight gain subsequently [published online ahead of print, 2023 Jun 14]. Diabet Med. 2023;e15166. doi:10.1111/dme.15166
2. Fornasini S, Miele F, Piras EM. The consequences of type 1 diabetes onset on family life. An integrative review. J Child Fam Stud. 2020; 29: 1467- 1483. doi:10.1007/s10826-019-01544