Prevention and early help for eating disorders in young people with type 1 diabetes

Abstract

There is building evidence that early intervention is key to improving outcomes in eating disorders, whereas a ‘watch and wait’ approach that has been commonplace among GPs and other healthcare professionals is now strongly discouraged. Eating disorders occur at approximately twice the rate in individuals with type 1 diabetes compared to the general population. In this group, standard eating disorder treatments have poorer outcomes, and eating disorders result in a particularly high burden of morbidity. Therefore, our first priority must be prevention, with early intervention where disordered eating has already developed. Clinicians working in both eating disorders and diabetes specialist services have highlighted the need for multidisciplinary team collaboration and specific training, as well as improved treatments. We review the current evidence and future directions for prevention, identification and early intervention for eating disorders in children and young people with type 1 diabetes.

Type 1 diabetes youth with disordered eating: Is there a disproportionate impact on ethnic minorities and indigenous peoples?

“…Health‐care professionals should bear in mind that DEB/ED in the T1D population can present as glycaemic instability which may display itself through higher HbA1c levels, active restriction or omission of insulin and recurrent presentations to hospital with diabetic ketoacidosis 18 . Depending on the extent and type of DEB/ED, other health‐related comorbidities such as osteoporosis, micronutrient deficiencies, cardiovascular conditions, dental complications and mental health issues may also co‐exist 10,13,19 . The combination of T1D and DEB/ED can be deleterious, with an increased risk of death and diabetes‐related microvascular complications, which is why health‐care providers involved in the care of young people with T1D must screen for DEB/ED and be cognisant of early warning signs 8,9,19 .…”

“…Neither of these tools enquire about excessive exercise as a weight control measure (to lose weight and/or increase muscularity), take into account gender and ethnic differences with regards to body image ideals in their body dissatisfaction questions, or have subscales to outline psychological traits 12,13 . SEEDS is a 20‐item questionnaire that includes items covering body image, feelings and quality of life, but weight control behaviours are not included 13 . EDI‐3RC has 25 items and includes subscales for body dissatisfaction, bulimia and drive for thinness 12,13 .…”

“…12,13 SEEDS is a 20-item questionnaire that includes items covering body image, feelings and quality of life, but weight control behaviours are not included. 13 EDI-3RC has 25 items and includes subscales for body dissatisfaction, bulimia and drive for thinness. 12,13 YEDEQ is a more extensive questionnaire with 45 items and has subscales for psychological traits including eating concern, weight concern and shape concern.…”

“…12 mSCOFF, EDI-3RC, YEDEQ were originally created for use in the general population but have been modified for use in the T1D population with the addition of question(s) about insulin restriction/omission behaviours for the purpose of weight control/loss. 2,3,9,12,13 When administering any of these screening tools users should be familiar with their strengths and limitations, the patient population they are intended for, and whether they should be used in conjunction with other validated tools for a more comprehensive assessment. 9, [14][15][16] Which adolescents with T1D should be screened for DEB/ED?…”

Eating Disorders, Self-Management, and Anxiety Disorders in Diabetics During the Covid-19 Pandemic: A Cross-Sectional Study

“…Given that diabetes generally develops before eating disorders in most patients, it may be a risk factor for developing eating disorders since diabetes requires strict dietary control. Early intervention, particularly increasing self-efficacy, can prevent these eating disorders [12]. Selfefficacy is related to an individual's belief in their abilities to change risky practices associated with eating behavior [13].…”