Developing a novel intervention for type 1 diabetes and disordered eating using a participatory action design process: Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY)

Background: People with type 1 diabetes are at increased risk of eating disorders. ‘Diabulimia’, ‘Syndrome of Insulin Omission’ and ‘Type 1 diabetes and Disordered Eating’ (T1DE) are all terms used to describe the omission or restriction of insulin in type 1 diabetes for fear of weight gain. For consistency, Type 1 diabetes and Disordered Eating (T1DE) is used throughout this article. The condition is associated with a significant increase in morbidity and mortality but is not yet recognised as a unique entity.Aim: To determine healthcare professional awareness and knowledge of eating disorders in type 1 diabetes.Methods: A short, cross-sectional, online healthcare professional survey across primary, secondary and community settings.Results: Healthcare professional confidence is low when it comes to recognising and supporting people with T1DE, but there is an interest in learning more.Conclusion: The findings from this study support strategies to improve healthcare professional awareness of T1DE.

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Disordered Eating Behaviors in Youth With Type 1 Diabetes

The Diabetes Educator ◽

10.1177/0145721705279049 ◽

2005 ◽

Vol 31 (4) ◽

pp. 572-583 ◽

Cited By ~ 41

Author(s):

Sarah Dion Kelly ◽

Carol J. Howe ◽

Jennifer Paige Hendler ◽

Terri H. Lipman

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Disordered Eating ◽

Eating Behaviors ◽

Treatment Options ◽

Screening Tools ◽

Disordered Eating Behaviors ◽

Chronic Hyperglycemia ◽

Increased Risk

Eating disorders are a significant health problem for many adolescents and are described as occurring along a spectrum of symptoms including disordered eating behaviors and clinical eating disorders. Poor self-esteem and body image, intense fear of gaining weight or refusal to maintain weight, and purging unwanted calories are clinical features of some eating disorders. Type 1 diabetes is a chronic illness with marked insulin deficiency. Chronic hyperglycemia creates a state of glucosuria with subsequent weight loss. Diabetes treatment focuses on intensive daily management of blood glucose by balancing insulin, food intake, and physical activity. Insulin omission offers an easy method for the purging of unwanted calories. The combination of these 2 illnesses is potentially deadly and also leads to an increased risk of poor diabetes outcomes. This includes poor metabolic control (measured by elevated hemoglobin A1C), increased risk of diabetic ketoacidosis, and microvascular complications such as retinopathy and nephropathy. Diabetes clinicians should be aware of the potential warning signs in an adolescent with diabetes as well as assessment and treatment options for eating disorders with concomitant type 1 diabetes. This article reviews the available data on the prevalence, screening tools, assessment guidelines, and treatment options for eating disorders in youth with type 1 diabetes.

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Eating Disorders and Disordered Eating Symptoms in Adolescents with Type 1 Diabetes

Nutrients ◽

10.3390/nu9080906 ◽

2017 ◽

Vol 9 (8) ◽

pp. 906 ◽

Cited By ~ 17

Author(s):

Giada Toni ◽

Maria Berioli ◽

Laura Cerquiglini ◽

Giulia Ceccarini ◽

Ursula Grohmann ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Disordered Eating ◽

Disordered Eating Symptoms

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Increased prevalence of disordered eating in the dual diagnosis of type 1 diabetes mellitus and celiac disease

Yearbook of Paediatric Endocrinology ◽

10.1530/ey.16.10.15 ◽

2019 ◽

Author(s):

Tokatly Latzer I ◽

Rachmiel M ◽

Zuckerman Levin N ◽

Mazor-Aronovitch K ◽

Landau Z ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Celiac Disease ◽

Type 1 Diabetes Mellitus ◽

Disordered Eating ◽

Dual Diagnosis

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Identifying and managing eating disorders in type 1 diabetes mellitus: An all-Wales study

Clinical Child Psychology and Psychiatry ◽

10.1177/13591045211009591 ◽

2021 ◽

pp. 135910452110095

Author(s):

Jacinta O A Tan ◽

Imogen Spector-Hill

Keyword(s):

Diabetes Mellitus ◽

Primary Care ◽

Eating Disorders ◽

Type 1 Diabetes ◽

Eating Disorder ◽

Type 1 Diabetes Mellitus ◽

Healthcare Professionals ◽

Health And Wellbeing ◽

Level Of Knowledge

Background: Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating disorders. Aim: To understand the level of knowledge and confidence amongst healthcare professionals in Wales regarding co-morbid T1DM and eating disorder presentations, identification and treatment. Results: We conducted a survey of 102 Welsh clinicians in primary care, diabetes services and eating disorder services. 60.8% expressed low confidence in identification of co-morbid T1DM and eating disorders. Respondents reported fewer cases seen than would be expected. There was poor understanding of co-morbid T1DM and eating disorders: 44.6% identified weight loss as a main symptom, 78.4% used no screening instruments, and 80.3% consulted no relevant guidance. The respondents expressed an awareness of their lack of knowledge and the majority expressed willingness to accept training and education. Conclusion: We suggest that priority must be given to education and training of all healthcare professionals in primary care, diabetes services and mental health services who may see patients with co-morbid T1DM and eating disorders.

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Prevention and early help for eating disorders in young people with type 1 diabetes

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104521994172 ◽

2021 ◽

pp. 135910452199417

Author(s):

Rosie Oldham-Cooper ◽

Claire Semple

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Early Intervention ◽

Young People ◽

Current Evidence ◽

Future Directions ◽

Team Collaboration ◽

Children And Young People ◽

Specialist Services

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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Eating Disorders in Adolescents with Type 2 and Type 1 Diabetes

Current Diabetes Reports ◽

10.1007/s11892-012-0355-7 ◽

2012 ◽

Vol 13 (2) ◽

pp. 289-297 ◽

Cited By ~ 30

Author(s):

Orit Pinhas-Hamiel ◽

Yael Levy-Shraga

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes

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Concurrent validity of self-report measures of eating disorders in adolescents with type 1 diabetes

Acta Paediatrica ◽

10.1111/j.1651-2227.2012.02738.x ◽

2012 ◽

Vol 101 (9) ◽

pp. 973-978 ◽

Cited By ~ 9

Author(s):

Helen d’Emden ◽

Libby Holden ◽

Brett McDermott ◽

Mark Harris ◽

Kristen Gibbons ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Concurrent Validity ◽

Self Report

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Low carbohydrate diets in eating disorders and type 1 diabetes

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104520980778 ◽

2020 ◽

pp. 135910452098077

Author(s):

Melissa Hart ◽

Kirrilly Pursey ◽

Carmel Smart

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Dietary Intake ◽

Dietary Restriction ◽

Eating Behaviours ◽

Optimal Outcomes ◽

Low Carbohydrate Diet ◽

Low Carbohydrate ◽

The Impact

Dietary intake requires attention in the treatment of both eating disorders and type 1 diabetes (T1D) to achieve optimal outcomes. Nutritional management of both conditions involves encouraging a wide variety of healthful foods in the context of usual cultural and family traditions. In recent times, low carbohydrate diets have seen a rise in popularity, both in T1D and in the general population. Low carbohydrate diets involve dietary restriction, although the extent depends on the level of carbohydrate prescription. Although dietary restriction is a known risk factor for eating disorders, there is limited literature on the impact of following a low carbohydrate diet on the development and maintenance of eating disorders in T1D. The aim of this review is to discuss the impact of dietary restriction on the development and treatment of eating disorders and propose considerations to enable optimum health outcomes in individuals with T1D, an at risk group. In order to achieve this, clarity regarding strategies that allow both flexibility in dietary intake and facilitate healthy eating behaviours, whilst achieving glycaemic targets, are required.

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