Adolescents with Type 1 Diabetes – The Impact of Gender, Age, and Health-Related Functioning on Eating Disorder Psychopathology

Abstract

ObjectiveTo investigate correlates of eating disorder psychopathology in adolescent males and females with type 1 diabetes.MethodA total of 105 adolescents with type 1 diabetes (42% males), aged 12–20 years, were recruited from the Norwegian Childhood Diabetes Registry in this population-based study. All participants were interviewed with the Child Eating Disorder Examination. Additionally, the Brief Illness Perception Questionnaire, the Adolescent Coping Orientation for Problem Experiences and the Beliefs about Medicines Questionnaire were administered to assess health-related functioning. Clinical data were obtained from the Norwegian Childhood Diabetes Registry.ResultsSignificant gender differences were demonstrated in the pattern of correlates of eating disorder pathology. Among females, eating disorder psychopathology was significantly associated with body mass index adjusted for age and gender, age, insulin restriction, coping, illness perceptions, and perceptions of insulin concern. In a regression model, age, illness perceptions, and insulin restriction remained significantly associated with eating disorder psychopathology, explaining 48% of the variance. None of the variables were associated with eating disorder psychopathology among males.DiscussionGreater clinical awareness of illness perceptions, attitudes toward insulin, and insulin restriction may potentially decrease the risk of developing eating disorders among female adolescents with type 1 diabetes, and the subsequent increased morbidity and mortality associated with comorbid type 1 diabetes and eating disorders.

Psychological barriers to optimal insulin therapy: more concerns in adolescent females than males

“…Insulin concerns are previously found to be associated with insulin restriction (reducing or omitting your insulin dose due to weight and shape concerns) and eating disorder psychopathology among adolescents with T1D 9. Insulin restriction and eating disorder pathology are significantly associated with poorer metabolic control and increased rates of morbidity and mortality,39 supporting the clinical importance of addressing insulin concern among young males and females with T1D.…”

“…23 Also, prior research has documented significant gender differences in the association between psychological aspects and HbA1c,8 as well as eating disorder psychopathology 9. In these studies, psychological aspects were significantly associated with HbA1c and eating disorder psychopathology among adolescent females, but not among males.…”

“…As described in previous studies,8 9 the NCDR is a nationwide, population-based registry, which includes all newly diagnosed children with diabetes since 1989. In the Norwegian healthcare system, all children aged 0–14.9 years with suspected diabetes are referred to a pediatric department.…”

“…1 Adolescents with T1D have been found to suffer from more psychological problems than non-diabetic peers, including depression, 2 3 anxiety, 4 and eating disorders. [5][6][7] Additionally, key clinical outcomes such as metabolic control (measured by glycated hemoglobin (HbA1c)) 8 and eating disorder psychopathology 9 have been shown to be significantly related to psychological aspects, including illness perceptions, insulin beliefs, and coping strategies.…”

“…9 Coping strategies (behaviors adopted to handle negative or stressful events) have been reported to be associated with metabolic control among adolescents and adults with T1D. For example, greater use of emotionfocused coping styles is found to be significantly associated with poorer metabolic control.…”