Personal Control and Disordered Eating in Female Adolescents With Type 1 Diabetes

Abstract

OBJECTIVE -The onset and subsequent management of diabetes can challenge one's sense of control. Sense of control can also be affected by the biological changes accompanying normal pubertal development. The negative impact on one's sense of control may be further exacerbated when both events (i.e., diabetes and puberty) occur in relatively close temporal proximity. RESEARCH DESIGN AND METHODS-This study examined the relationship between sense of control and disordered eating and glycemic control in 45 female adolescents with type 1 diabetes.RESULTS -A lower sense of overall control and a lower sense of bodily control were both directly related to more severe eating-disordered symptoms. However, a lower sense of overall control and lower bodily control were related to poorer metabolic control primarily when the diagnosis of diabetes occurred closer to the onset of puberty.CONCLUSIONS -Clinicians should assess and monitor perceptions of control and also consider the temporal proximity of disease onset and onset of puberty when managing type 1 diabetes in female adolescents. Diabetes Care

Systematic review and meta-analysis of the efficacy of interventions for people with Type 1 diabetes mellitus and disordered eating

“…This leads to wide blood glucose fluctuations (hypo-and hyperglycaemia), which may cause neuroadaptive changes that pre-dispose to an addictive pattern of loss of control over eating to develop [19,23,24]. Family support may be crucial at this time [26,27], but it remains unclear what the optimum way to transition from family to independent management might be. Family support may be crucial at this time [26,27], but it remains unclear what the optimum way to transition from family to independent management might be.…”

Understanding the developmental and psychological needs of young people with diabetes

“…Many authors have proposed causal mechanisms for this increased eating disturbance a summary of which is beyond the scope of this paper. In general, however, young women with type 1 diabetes have higher BMIs in comparison to their contemporaries; there may also be issues around ‘control’ with a lower sense of personal control and bodily control being related to poorer glycaemic control—this appears to be exacerbated by a diagnosis of diabetes closer to the onset of puberty 23…”

The practical management of patients with type 1 diabetes requiring in-patient care due to an eating disorder

“… The onset of diabetes as a life stress 28 The effects of diagnosis of diabetes on family functioning and dynamics. Anxieties about short‐term issues in diabetes management such as episodes of hypoglycaemia,29 episodes of diabetic ketoacidosis, and the potential of complications in the long term. A feeling of loss of control over one's body, which is associated with management of diabetes and daily life 28. Fearing loss of control is a central feature of eating disorders. The focus of diabetes management is expressed through ‘control’, i.e.…”

“…Tight glycaemic control in type 1 diabetes is associated with a heavier body weight than non‐diabetic peers21, 33, 34 and intensification of glycaemic control in type 1 diabetes commonly leads to an overweight state;14, 21, 35 heavier body weight predisposes to greater body image dissatisfaction 16, 21, 36. Weight gain is potentially unsettling for those individuals with a high value placed on control of body weight28 and the risk of weight gain is likely to exacerbate fear in vulnerable individuals. Frequent attempts at dieting or strict rigid attention to food 16, 25. Dieting, and restrictive eating, are major risk factors for the development of an eating disorder.…”