Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self‐care behaviour and emotion

Abstract

Objectives Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self‐care behaviour and emotional state of women with type 1 diabetes and disordered eating. Research design and methods In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case–control study. We used a mixed‐methods approach with a 7‐day blinded continuous glucose monitoring and real‐time record of non‐prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann–Whitney U test or Fisher's exact test. We conducted thematic analyses of free‐text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags. Results People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9 mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p = 0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7 mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p = 0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15 mmol/L). Conclusions Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus

“…Anthropometric and psychometric characteristics for the sample are well described elsewhere should readers require more information about the clinical features of the sample. 12 Two semi-structured interviews (Supporting Information S1 and S2) were developed iteratively after a review of online blogs by people with type 1 diabetes and disordered eating, 16 and discussions with an expert advisory board with personal and professional experience (psychiatrists, clinical psychologists, clinical researchers, physicians and diabetes specialists including a diabetes nurse specialist).…”

“…Our previous work on glucose monitoring in individuals with personal experience of type 1 diabetes and disordered eating highlights a complex interaction between glycaemia, negative emotion and self care behaviours in this cohort. 12 Therefore, we aimed to develop a cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experiences, obtained by semi-structured interviews. This involved using a novel analytic approach which combined categories derived from qualitative methodology (grounded theory), and individual cognitive behavioural therapy formulations to identify and describe the psychological processes that predicate disordered eating and insulin omission and strategies adopted to aid recovery.…”

PaRent InterventiOn to pRevent dIsordered eating in children with TYpe 1 diabetes (PRIORITY): Study protocol for a feasibility randomised controlled trial

“…5 These eating behaviours are costly to both the individual, family and the health system, resulting in blood glucose fluctuations, repeated hospital admissions, impaired wellbeing and early mortality. 6,7 Given the severity of disordered eating and T1D, a small number of specialist programmes that address clinically significant eating disorders and their intersection with T1D have been developed. 8,9 However, given the interrelationships between T1D and disordered eating, individuals/families, clinicians and academics are calling for early intervention to prevent the development of clinical eating problems in this population.…”

Association of executive function problems and disordered eating behaviours in teens with type 1 diabetes

“…For example, worries about body image and weight may lead to disordered eating behaviours and clinical eating disorders 8 . In persons with type 1 diabetes, disordered eating behaviours are associated with higher glucose levels, diabetes complications and premature mortality 9–11 . Screening for psychosocial concerns and self‐care deficits is recommended in persons with type 1 diabetes due to the potential impact on diabetes management, well‐being and short‐ and long‐term physical health, as well as to avoid progression to clinical mental health conditions, such as eating disorders 12 …”