Disturbed eating behavior common in youth with type 1 diabetes
medwireNews: Approximately one-third of adolescents and young adults with type 1 diabetes display disturbed eating behavior (DEB) that may be linked to worsening glycemic control and increasing depressive symptoms over time, research shows.
Furthermore, “DEB was found to be unrelated to age and illness duration, indicating that DEB occurred at any age and at any stage in the illness trajectory,” Koen Luyckx (University of Leuven, Belgium) and co-investigators remark.
For the study, 300 adolescents and young adults (16–28 years) with type 1 diabetes responded to questionnaires measuring DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms at baseline (T1) and 1 year later (T2).
Overall, the mean DEPS-R score remained stable from T1 (13.15 points) to T2 (12.71 points) but was significantly higher in females than males at both timepoints (T1: 16.53 vs 8.71 points, T2: 15.57 vs 8.96 points).
Using a DEPS-R cutoff of 18, which signals individuals in need of further evaluation, the researchers created four categories of DEB: low DEB (DEPS-R <18 at T1 and T2), increasing DEB (<18 at T1 and ≥18 at T2), decreasing DEB (≥18 at T1 and <18 at T2), and persistent DEB (≥18 at T1 and T2). The proportions of patients in each category were 65.7%, 8.0%, 7.3%, and 19.0%, respectively.
There were no differences between these four groups in the type of insulin therapy they were using, but levels of insulin restriction and omission, diabetes-specific functioning, and depressive symptoms differed significantly among them.
For example, at T1 and T2, 8.1% and 4.1% of people in the low DEB group, respectively, said they restricted insulin at least sometimes. The corresponding proportions were 8.3% and 33.3% for the increasing DEB group, 31.8% and 9.1% for the decreasing DEB group, and 36.8% and 22.8% for the persistent DEB group.
A similar pattern was seen for insulin omission, with 0.5%, 8.3%, 18.2%, and 10.5% of people in the low, increasing, decreasing, and persistent DEB groups, respectively, saying they omitted insulin at least sometimes at T1. At T2, the corresponding proportions were 0.5%, 20.8%, 0.0%, and 8.8%.
There were no significant interactions with sex for insulin restriction or omission and Luyckx and team comment that “the high occurrence of insulin restriction and omission found in the current study highlights the need for explicit attention to DEB in male youth as well [as female youth], as DEB often goes undetected in boys and men.”
People in the low DEB group had the lowest scores for diabetes distress, depressive symptoms, and glycated hemoglobin (HbA1c) and the highest scores for self-management at T1 and T2. Conversely, people with persistent DEB had the highest scores for diabetes distress and depressive symptoms, and the second highest HbA1c at both time points.
The investigators also found that self-management decreased when DEB increased, and vice versa, which they say highlights “the need for assessing DEB prospectively.”
Furthermore, cross-lagged analyses suggested that DEB at T1 predicted significant increases in HbA1c over time as well as marginal increases in depressive symptoms.
“This prospective link with depressive symptoms merits special attention given the associations of depressive symptoms with worse self-management and glycemic control and increased health care costs,” Luyckx and co-authors write in Diabetes Care.
And they conclude: “Given the prospective changes observed, it may be valuable to integrate the assessment of DEB and eating disorders in the vulnerable age-group of adolescence and emerging adulthood into routine clinical care.
“DEB can emerge at any time during the illness trajectory and, for some individuals, the severity of DEB may change substantially over time.”
By Laura Cowen
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