Test of the modified dual pathway model of eating disorders in individuals with type 1 diabetes

Abstract

Objective: Adolescents and young adults with type 1 diabetes (T1D) demonstrate high rates of disordered eating behaviors (DEBs) and may experience physiological and psychological vulnerabilities not currently included in established risk models of DEBs. This study examined associations among constructs included in the recently proposed T1D-specific modified dual pathway model and examined age as a moderator of these associations.Method: Participants included adolescents (n = 307; age M = 15.71, SD = 1.33), young adults (n = 313; age M = 21.20, SD = 2.10), and adults (n = 198; age M = 30.51, SD = 2.81) recruited via the T1D Exchange Clinic Registry. Data were collected from participants' medical records and from self-report questionnaires assessing dietary regimen, dietary restraint, body dissatisfaction, hunger/satiety, diabetes-specific negative affect, and DEBs. Multiple group path modeling was used to test hypotheses.Results: Approximately 31% of participants were at risk for an eating disorder. The original modified dual pathway model had poor model fit. The addition of three empirically defensible paths improved model fit. Diabetes-specific dietary regimen, diabetes-specific negative affect, and hunger/satiety disruption all were associated with DEBs. A fully varying multiple group model by age fit best; however, only the dietary restraint to DEBs pathway demonstrated a distinct pattern across age cohort, which attenuated from the adolescent to the adult cohort.Discussion: This study provides preliminary support for associations proposed in the modified dual pathway model and suggests potential for intervening on diseasespecific risk factors of DEBs in a T1D population. K E Y W O R D Sadolescent, eating disorder, hunger, type 1 diabetes, young adult

25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt?

“…Recent research has shown empirical support in youth and young adults with type 1 diabetes for the link between disordered eating and certain aspects of this model (e.g. hunger/satiety disruption, dietary regimen, negative affect) . In parallel to development of the modified dual pathway model, Treasure et al .…”

“…to be a salient feature in both restrictive and disinhibited subtypes, as it may be characterized as a control-seeking behaviour (when combined with dietary restraint or perfectionistic attitudes) or a compensatory purging behaviour (e.g. when engaged in after an episode of binge eating) [14,15]. Profiles or subtypes of disordered eating in type 1 diabetes may also differ with respect to their trajectories, with some investigations noting variability in the persistence of symptoms over time [5,6,16].…”

“…Recent research has shown empirical support in youth and young adults with type 1 diabetes for the link between disordered eating and certain aspects of this model (e.g. hunger/satiety disruption, dietary regimen, negative affect) [15,35]. In parallel to development of the modified dual pathway model, Treasure et al [14] proposed a new theoretical maintenance model of disordered eating in type 1 diabetes, taking into account aspects of Fairburn's transdiagnostic model [S8] and the dual pathway model.…”

Gestörtes Essverhalten und psychosoziale Versorgungssituation junger Menschen mit Typ 1 Diabetes

“…Aufgrund der bedeutsamen somatischen Konsequenzen bereits sub- klinisch gestörten Essverhaltens bei Menschen mit Diabetes ist eine frühzeitige Identifizierung der Betroffenen in der Praxis elementar. Regelmäßiges Screening in internistischen Diabetes-Schwerpunktpraxen im Kontext der Diabetesbehandlung erscheint aufgrund der hohen Prävalenz gestörten Essverhaltens in dieser Patientengruppe empfehlenswert, um Betroffene frühzeitig zu identifizieren, zu informieren und bei Bedarf eine Behandlung in die Wege zu leiten [30]. Zudem fanden sich bei den Teilnehmenden mit Auffälligkeiten im Essverhalten signifikant häufiger u. a. schwere Ketoazidosen und Krankenhausaufenthalte im letzten Jahr.…”

“…In der vorliegenden Studie erwiesen sich u. a. das HbA1c, der BMI, das Geschlecht und diabetesbezogene Belastungen (PAID-5) als bedeutsame Prädiktoren für das Ausmaß gestörten Essverhaltens. Auch Rancourt und Kollegen fanden, dass diabetesspezifische Belastungen mit einem höheren Ausmaß an gestörtem Essverhalten einhergingen [30]. Bei der Diabetesdauer zeigte sich ein kleiner Effekt für eine kürzere Diabetesdauer als Prädiktor für gestörtes Essverhalten.…”