Disturbed eating behaviors in adolescents with type 1 diabetes. How to screen for yellow flags in clinical practice?

Abstract

Half of the adolescents reported body and weight concerns, less than 1 in 10 reported DEBs. Screening for yellow flags for DEBs as a part of clinical routine using a stepwise approach and early assistance is recommended to prevent onset or deterioration of DEBs.

Increased prevalence of disordered eating in the dual diagnosis of type 1 diabetes mellitus and celiac disease

“…45 However, others have reported a positive association between HbA1c and DEBs. [46][47][48][49][50] This may either reflect the natural propensity of poor glycemic control, which is typical to adolescent age, or result from the relatively small sample size of those diagnosed with DEBs.…”

Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

“…The DEPS-R (8,24) includes 16 items. As in Eilander et al (8), the item referring to ketones was excluded as not all Belgian youth are familiar with the exact meaning of ketones. Items are answered on a 6-point scale ranging from 0 (never) to 5 (always) and address general (e.g., "I feel that my eating is out of control") and diabetes-specific DEB in terms of insulin restriction and omission (e.g., "After I overeat, I skip my next insulin dose").…”

“…magnitude of this problem in boys seems less extensive but still troublesome (2), with up to 10% reporting substantial DEB (4). Further, youth with type 1 diabetes may turn to insulin restriction or omission for manipulating their body weight, resulting in rapid weight loss (8,9). This phenomenon is quite prevalent, as 20-40% of youth (and especially females) (2,10) engage in it (8,11,12), leading to long-term insulin misuse, morbidity, and even mortality (13,14).…”

“…Further, youth with type 1 diabetes may turn to insulin restriction or omission for manipulating their body weight, resulting in rapid weight loss (8,9). This phenomenon is quite prevalent, as 20-40% of youth (and especially females) (2,10) engage in it (8,11,12), leading to long-term insulin misuse, morbidity, and even mortality (13,14). Consequently, a need for more attention to DEB in youth with type 1 diabetes has recently been highlighted as an important clinical guideline (15,16).…”

“…The strong focus on food in relation to blood glucose regulation and the dietary restraints possibly playing into perfectionistic attitudes may be causing DEB in type 1 diabetes (7,8,11,(17)(18)(19). Given the societal pressure to obtain the perfect ideal body (20), adolescents especially seem to be at risk for developing DEB, as they are particularly vulnerable to body dissatisfaction (18,21).…”