Diabetes-specific eating disorder and possible associated psychopathologies in adolescents with type 1 diabetes mellitus

Abstract

Purpose It was aimed to investigate the frequency of the risk of diabetes-specific eating disorder (DSED) in adolescents with type 1 diabetes mellitus (T1DM) and to reveal the accompanying psychopathologies. Methods Adolescents with T1DM aged 12–18 who applied to the pediatric diabetes outpatient clinic between July 2021 and March 2022 were included. Diabetes Eating Problem Survey-Revised (DEPS-R) was applied to all patients to determine the risk of DSED. In order to detect accompanying psychopathologies, Eating Disorder Examination Questionnaire (EDE-Q), Child Anxiety and Depression Scale-Child version (RCADS) and Parenting Style Scale were applied. After completing the scales, semi-structured interviews were conducted with all patients by a child and adolescent psychiatrist. Results Ninety-two adolescents (45 boys, 47 girls) were included. DSED risk was found in 23.9% of the cases. A positive correlation was found between DEPS-R and EDE-Q scores (p = 0.001, rho = 0.370). RCADS mean scores were significantly higher in the group with DSED risk (p < 0.001). When the Parenting Style Scale was evaluated, psychological autonomy scores were significantly lower in the group with DSED risk (p = 0.029). As a result of the psychiatric interviews, 30 (32.6%) patients had at least 1 psychiatric disorder. Of these, 2 patients were diagnosed with eating disorder. Conclusion Almost one-fourth of adolescents with T1DM were found to be at risk of DSED. Routine screening of adolescents with T1DM with the DEPS-R scale may provide early detection of DSED, and referral of those at risk to child psychiatry enables early diagnosis and intervention for both eating disorders and accompanying psychopathologies. Level of evidence Level III: Evidence obtained from cohort or case-control analytic studies.

Implementing Screening for Eating Disorders in Adolescents and Young Adults with a History of Cancer

“…6 Indeed, this has been reported in other adolescents with chronic conditions, such as systemic lupus erythematosus (SLE), diabetes mellitus, and chronic hypertension. 5,7,8 One review of patients with juvenile SLE patients demonstrated an association between SLE and anorexia nervosa. In this review, it was suggested that these patients developed anorexia due to the chronic use of steroids and the subsequent body-image issues secondary to steroid-related body changes.…”

“…7 Adolescent patients with diabetes mellitus are at 2-3 times higher risk than the general population to develop an eating disorder, with a prevalence anywhere between 15-40%. 8 This is the case as patients with diabetes must adhere to a strict medication regimen that emphasizes portion and weight control, leading to food preoccupation. 8,9 Underdosing or skipping insulin doses entirely is commonly used as a form of weight loss among these patients, as this both helps patient lose weight and gives them a sense of independence and control over their treatment.…”

“…8 This is the case as patients with diabetes must adhere to a strict medication regimen that emphasizes portion and weight control, leading to food preoccupation. 8,9 Underdosing or skipping insulin doses entirely is commonly used as a form of weight loss among these patients, as this both helps patient lose weight and gives them a sense of independence and control over their treatment. 8,9 The same has been noted in adolescent patients with chronic hypertension due to the emphasis on lifestyle modification, including diet and exercise.…”

“…8,9 Underdosing or skipping insulin doses entirely is commonly used as a form of weight loss among these patients, as this both helps patient lose weight and gives them a sense of independence and control over their treatment. 8,9 The same has been noted in adolescent patients with chronic hypertension due to the emphasis on lifestyle modification, including diet and exercise. 5 The above supports our hypothesis that AYA oncology patients are at high risk for the development of eating disorders given several similar characteristics with patients with SLE, diabetes, and chronic hypertensionincluding treatment with weight-altering therapies, emphasis on weight and nutrition, stringent treatment regimens, and significant stress -and therefore should be routinely screened.…”