Disturbed Eating Behavior and Omission of Insulin in Adolescents Receiving Intensified Insulin Treatment

Abstract

OBJECTIVETo establish the prevalence of disturbed eating behavior (DEB) and insulin omission among adolescents with type 1 diabetes using intensive insulin treatment in a nationwide population-based study.RESEARCH DESIGN AND METHODSThe Diabetes Eating Problem Survey–Revised (DEPS-R) is a diabetes-specific screening tool for DEB. Clinical data and HbA1c were obtained from the Norwegian Childhood Diabetes Registry.RESULTSA total of 770 children and adolescents 11–19 years of age with type 1 diabetes completed the DEPS-R. A total of 27.7% of the females and 8.6% of the males scored above the DEPS-R cutoff. Participants scoring above the cutoff had significantly higher HbA1c (9.2% [77 mmol/mol]; SD, 1.6) than participants scoring below the cutoff (8.4% [68 mmol/mol]; SD, 1.3; P < 0.001). The prevalence of DEB increased significantly with age and weight, from 7.2% in the underweight group to 32.7% in the obese group, and from 8.1% in the youngest age-group (11–13 years) to 38.1% in the oldest age-group (17–19 years). A total of 31.6% of the participants reported insulin restriction and 6.9% reported insulin omission after overeating. Patients reporting insulin restriction had significantly higher HbA1c (9.0% [75 mmol/mol]; SD, 1.7) than nonrestrictors (8.3% [67 mmol/mol]; SD, 1.2; P < 0.001).CONCLUSIONSOne-fourth of girls with type 1 diabetes scored above the cutoff for DEB and one-third reported skipping their insulin dose entirely at least occasionally after overeating. Both DEB and insulin restriction were associated with poorer metabolic control, which may increase the risk of serious late diabetes complications.

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

“…The burden of diabetes and of the associated therapy with a major focus on food and eating pattern may contribute to this type of disordered eating in T1DM males. Previous small studies indicated also a level of disturbed eating (e.g., insulin restriction or skipping, higher drive for thinness) in male T1DM patients (4,20,36). However, in small studies from Austria and Sweden, no male with T1DM had an ED based on DSM-IV criteria (4,20).…”

Medical Complications of Anorexia Nervosa and Bulimia

“…This accelerates microvascular complications. 93 NEUROLOGIC Brain atrophy changes occur as a result of the malnutrition of anorexia nervosa.…”

Adolescents with Diet-Related Chronic Health Conditions (DRCHCs) and Unique Risk for Development of Eating Pathology

“…It is crucial to assess for DEBs in this population, as they may further impair metabolic control and contribute to the development of complications such as diabetic retinopathy [28]. DEBs among those with T1D have been found to increase throughout adolescence, with approximately 33% of 14-16-year-old girls endorsing that they have engaged in these behaviors, while approximately 50% of 17 to 19 year olds reported engaging in DEBs [29,30]. DEBs may be less prevalent, yet still significant, among adolescent boys; approximately 7% of 14-16 year olds and 15% of 17-19 year olds with T1D reported engaging in DEBs [29,30].…”

“…Examination of this unique form of DEB, indicated that between 10.3-26.2% of girls and 1.4-4.5% of boys with diabetes have skipped doses of insulin to control weight, while 7.4-36.8% of girls and 1.4-9.4% of boys have administered lower doses of insulin than they were prescribed to control weight [29,30]. Jones and colleagues [27] found insulin omission to be the second most commonly utilized form of weight control among those with T1D, indicating that this behavior is common among those with T1D who are attempting to control weight.…”