Screening Practices for Disordered Eating in Paediatric Type 1 Diabetes Clinics

Background: Type 1 Diabetes (T1D) is associated with increased risk of eating disorders. This study aimed to (1) assess adherence of Australasian paediatric T1D clinics to international guidelines on screening for disordered eating and (2) identify barriers and enablers to the use of screening tools for the identification of disordered eating. Methods: A 24-item survey covering five content domains: clinic characteristics, identification of disordered eating, screening tool use, training and competence, and pathways for referral, was sent to Australasian clinics caring for ≥150 children and adolescents with T1D. Results: Of 13 eligible clinics, 10 participated. Two reported rates of disordered eating of >20%, while eight reported rates < 5%. All clinics used the routine clinical interview as the primary method of screening for disordered eating. Only one used screening tools; these were not diabetes-specific or routinely used. Barriers to use of screening tools included shortage of time and lack of staff confidence around use (n = 7, 70%). Enablers included staff training in disordered eating. Conclusions: Screening tools for disordered eating are not utilised by most Australasian paediatric T1D clinics. Overall, low reported rates of disordered eating suggest that it may be undetected, potentially missing an opportunity for early intervention.

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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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Brief Screening Tool for Disordered Eating in Diabetes: Internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes

Diabetes Care ◽

10.2337/dc09-1890 ◽

2009 ◽

Vol 33 (3) ◽

pp. 495-500 ◽

Cited By ~ 123

Author(s):

J. T. Markowitz ◽

D. A. Butler ◽

L. K. Volkening ◽

J. E. Antisdel ◽

B. J. Anderson ◽

...

Keyword(s):

Type 1 Diabetes ◽

Disordered Eating ◽

Internal Consistency ◽

External Validity ◽

Pediatric Patients ◽

Screening Tool ◽

Contemporary Sample ◽

Brief Screening

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Healthcare professional awareness of eating disorders in people with type 1 diabetes: a staff survey

British Journal of Diabetes ◽

10.15277/bjd.2020.268 ◽

2020 ◽

Vol 20 (2) ◽

pp. 122-129

Author(s):

Sarah Brewster ◽

Helen Partridge ◽

Caroline Cross ◽

Hermione Price

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Healthcare Professional ◽

Disordered Eating ◽

Cross Sectional ◽

Increased Risk ◽

Study Support ◽

Professional Confidence ◽

Fear Of Weight Gain

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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Choosing a screening tool to assess disordered eating in adolescents with type 1 diabetes mellitus

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2014.09.008 ◽

2015 ◽

Vol 29 (1) ◽

pp. 2-4 ◽

Cited By ~ 1

Author(s):

Helen d’Emden ◽

Brett McDermott ◽

Kristen Gibbons ◽

Mark Harris ◽

Andrew Cotterill

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Disordered Eating ◽

Screening Tool

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Risk of Disordered Eating Behaviors in Adolescents with Type 1 Diabetes

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsaa027 ◽

2020 ◽

Vol 45 (5) ◽

pp. 583-591

Author(s):

Meredith Rose ◽

Randi Streisand ◽

Carrie Tully ◽

Lauren Clary ◽

Maureen Monaghan ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Negative Affect ◽

Disordered Eating ◽

Eating Behaviors ◽

Self Management ◽

Negative Urgency ◽

Disordered Eating Behaviors ◽

Increased Risk

Abstract Objective Management of type 1 diabetes (T1D) may be difficult for adolescents, who often fail to meet glycemic targets. Adolescents are also at an increased risk for negative affect (i.e., anxiety, depressive symptoms) and are prone to disordered eating behaviors (DEB). This study hypothesized that negative affect would be associated with DEB, self-management, and glycemic control, but that this would be moderated by negative urgency (the urge to engage in impulsive behaviors in response to negative affect), such that this relationship would be significant only for those with higher negative urgency. Methods The Eating in Adolescents with T1D Study recruited 100 caregiver-adolescent dyads (55% male youth, 48% Caucasian) to complete questionnaires reporting on the adolescent’s negative affect, negative urgency, DEB, and diabetes management. Glycemic control 3–4 months following survey completion was extracted from the medical record. Results A total of 61% of adolescents reported elevated symptoms of anxiety or depression and 25% reported elevated disordered eating symptoms. A total of 81% of adolescents had an A1c level above recommended targets. Negative affect was associated with DEB, suboptimal T1D self-management, and suboptimal glycemic outcomes, moderated by higher levels of negative urgency. Negative affect was associated directly with suboptimal self-management and glycemic control, but not DEB, at all levels of negative urgency. Conclusions Adolescents reported high levels of negative affect, DEB, and suboptimal glycemic control. Interventions that target negative affect and negative urgency in adolescents with T1D are needed in order to reduce the risk for DEB and negative diabetes health outcomes.

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A Study on Impaired Awareness of Hypoglycaemia in Type 1 Diabetes Patients in a Tertiary Care Centre in Singapore

10.22541/au.161951857.79594520/v1 ◽

2021 ◽

Author(s):

Marvin Chua ◽

Ester Yeoh ◽

Sharon Fun ◽

Angela Koh

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Severe Hypoglycaemia ◽

Screening Tools ◽

Sensitivity Factor ◽

Increased Risk ◽

Impaired Awareness Of Hypoglycaemia ◽

Impaired Awareness ◽

Clinically Significant

Background: This study aims to establish the frequency of severe hypoglycaemia and impaired awareness of hypoglycaemia (IAH) in Type 1 diabetes (T1D) patients in Singapore. We evaluate the utility of the Gold and Clarke scores as screening tools for IAH, and assess the effects of diabetes self-management practices and education in reducing IAH. Methods: This is an observational study of 131 subjects with T1D at a regional hospital, which included review of medical records, self-administered questionnaires and a prospective 4 week period of self-monitoring of blood glucose (SMBG). Results: The frequency of clinically significant hypoglycaemia (blood glucose < 3 mmol/L) during the 4 week period of SMBG was 38.8%, while the frequency of severe hypoglycaemia over the last one year was 22.5%. Based on the Gold score and Clarke score, 28.3% and 24.6% of subjects respectively had IAH. The Clarke score was associated with increased frequency of clinically significant hypoglycaemia, severe hypoglycaemia and hospitalizations for hypoglycaemia. Prior group education, education from a dietitian and education on blood glucose targets were associated with lower Clarke scores, while adjusting insulin doses for blood glucose using an insulin sensitivity factor was associated with lower Gold and Clarke scores. Conclusion: IAH is common in T1D patients in Singapore and is associated with increased risk of severe hypoglycaemia. The Gold and Clarke scores are simple tools which can be routinely administered to identify patients with IAH who might benefit from specific interventions, particularly structured diabetes education, to decrease IAH and its complications.

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Can having a sibling with type 1 diabetes cause disordered eating behaviors?

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2017-0533 ◽

2018 ◽

Vol 31 (7) ◽

pp. 711-716

Author(s):

Sinem Akgül ◽

Ayfer Alikaşifoğlu ◽

Alev Özon ◽

Nazlı Gönç ◽

Yasemin Düzçeker ◽

...

Keyword(s):

Type 1 Diabetes ◽

Disordered Eating ◽

Eating Behaviors ◽

Dietary Habits ◽

Eating Attitudes ◽

Control Group ◽

Dietary Recall ◽

Increased Risk ◽

Eat 26

Abstract Background Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating disturbances. The aim of this study was to evaluate whether the risk of a disordered eating behavior (DEB) also applies to the well sibling sharing the same environment. Methods Well siblings were included if they were 10–18 years old, had a sibling with a T1DM diagnosis for at least 6 months and lived with the sibling during the illness. The control group was comprised of healthy participants recruited from the outpatient clinic with no family history of T1DM. Participants completed a four-part questionnaire concerning their eating behaviors that was developed by the study team. This survey aimed to evaluate the dietary habits and eating patterns. All participants completed the Eating Attitudes Test-26 (EAT-26) and a 24-h food dietary recall. Any participant with a high EAT-26 score or that seemed to be at risk according to the questionnaire was re-evaluated. Results Eight cases (33.3%) in the well sibling group had either a total and/or subgroup pathological score. Three of them were found to have DEB and one case was diagnosed with anorexia nervosa (AN). In the control group, five cases (17.2%) had either a total and/or subgroup pathological score. Three of these cases were found to have DEB, no cases were diagnosed with an eating disorder. There were no statistically significant differences in the EAT-26 scores between the groups. Conclusions Although a direct relationship was not observed, the probability of having a pathologic EAT-26 score was higher in the group with a sibling with T1DM.

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