Eating Disorders Common in Youth with Type 1 Diabetes

Nearly 1 in 5 children and adolescents with type 1 diabetes — and 1 in 4 females — has disturbed eating behavior….

In the study, disturbed eating behavior (DEB) refers to both clinical and subclinical eating disorders. When present in patients with type 1 diabetes (T1D), DEB can severely impair metabolic control, accelerate the development of diabetes complications, and is associated with increased mortality, the authors note.

DEB has been shown to be persistent and worsen over time in patients with T1D, suggesting that early intervention is very important to minimize the risk of diabetes complications. Whereas most previous studies looking at this phenomenon in patients with type 1 diabetes have used generic measures of eating disorders, this study is the first to assess prevalence of DEB in youth with type 1 diabetes using the newly developed 16-item Diabetes Eating Problem Survey-Revised (DEPS-R).

The use of diabetes-specific screening tools is important because many of the flagged behaviors suggesting eating disorders in the general population — such as eating when not hungry or preoccupation with food — are natural manifestations of type 1 diabetes. Conversely, the generic tools don’t assess diabetes-specific problem behaviors such as insulin restriction.

The DEPS-R was administered to 770 youth aged 11 to 19 years who were recruited from the Norwegian Childhood Diabetes Registry, which includes more than 95% of all young patients in Norway with type 1 diabetes. Whereas many other DEB studies have focused primarily on females, males made up half (49.4%) of this study sample.

The group had a mean age 14.6 years, and mean diabetes duration of 5.3 years. Most used insulin pumps (56%) or took at least 4 insulin shots per day.

Using a predetermined cutoff of 20 or higher on the DEPS-R (each item is rated on a 6-point scale), the researchers identified DEB in 18.3% of the entire group, 27.7% of the females, and 8.6% of the males.

The proportions were dramatically higher among the older group of 153 patients aged 17 to 19 years, in whom DEB was identified in 32.7% overall and in 49.4% of the females and 14.5% of the males. In contrast, all of those rates were less than 10% among the 11- to 13-year-olds.

Overweight youth were much more likely to have DEB, with rates of 28.9% among the 147 classified as overweight and 38.1% of the 22 obese youth, compared with just 14.9% of the 533 with normal weight. The relationship between DEB and body weight was particularly strong among the females. Hemoglobin A_1c levels were significantly higher among the patients with DEB compared with those without, 9.2% vs. 8.4% (P < .001).

Hemoglobin A_1c was also significantly higher among those who reported insulin restriction, 9.0% vs. 8.3% (P < .001).

Diabetes Care. August 20, 2013. Abstract