Clinical features at T1D diagnosis may predict disrupted eating behavior

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A new study suggests that disrupted eating behavior is common among adolescents with type 1 diabetes (T1D), with nearly a third of the study cohort showing scores indicating trouble eating. ing.1

The results show various clinical features that predict the development of eating behavior disorders, such as body mass index (BMI) score at diagnosis and rate of weight gain after diagnosis in female patients.

The investigative team, led by Tamar Plopper-Lewinson of the National Children’s Center for Endocrinology and Diabetes Institute, said, “Our findings suggest that efforts to prevent eating disorders in adolescents with T1D should begin as soon as possible after the onset of symptoms. suggests,” he wrote. Diabetes at the Schneider Children’s Medical Center in Israel. “Furthermore, the prevalence of disordered eating behavior in this population justifies regular screening, preventative measures and early intervention.”

A childhood T1D diagnosis can be traumatic for both the child and the family. At diagnosis, weight loss due to insulin deficiency is usually followed by rapid weight gain after initiation of insulin therapy. Unwanted weight gain can later lead to disrupted eating behavior and reduced adherence to insulin treatment.2

A variety of eating disorders that do not fit a formal diagnosis include overeating, restricted food intake, strict dietary rules, and weight loss elimination. In adolescents with T1D, disrupted eating behavior includes overeating and elimination followed by insulin restriction or omission. The combination of this disease and disrupted eating behavior is associated with poor glycemic control, increased risk of short- and long-term complications, and risk of death.

For the present analysis, Propper-Lewinsohn et al. sought to assess the prevalence of disordered eating behavior and disease-related risk factors for its development in young people with T1D. The researchers also looked for disease-diagnostic risk factors that might predict the development of disordered eating behavior. To this end, we performed an observational, retrospective study of T1D adolescents aged 15 to 19 years who were being treated at the research center’s diabetes clinic.

Each study participant completed the revised Diabetes Eating Problem Survey (DEPS-R) to be screened for disrupted eating behavior. The DEPS-R is a 16-item diabetes-specific self-report screening tool for eating disorders, with scores ranging from 0 to 80 points. It includes a variety of special topics on disordered eating behavior, including the urge to lose weight, feeding medical conditions, and diabetes management. A score of 20 or higher suggests a high risk of disordered eating behavior.

From medical records at the end of the study, the research team determined the study participants’ age, gender, anthropometric measurements, duration of diabetes, hemoglobin A1c, insulin therapy, use of continuous glucose monitoring (CGM), co-morbidities such as celiac disease. Clinical data were collected. DEPS-R survey. A total of 297 adolescents completed his DEPS-R questionnaire, and his 291 adolescents (45.4%) after exclusion were included in the analysis. Of this population, 84 participants (28.9%) had scores above the threshold of 20, suggesting a high risk of disrupted eating behavior.

As a result of the analysis, disturbance of eating behavior was positively correlated with BMI-z score (r = .24; P. <.001) and HbA1c (r = .39; P. <.001). A linear regression analysis of the variables associated with the DEPS-R score revealed female sex (β, 3.01; P. = .002), higher BMI z-score (β, 2.08; P. <.001), high HbA1c (β, 0.19; P. <.001), multiple daily insulin injections (β, 2.19; P. = .032).

Multivariate linear regression in children diagnosed before age 13 identified higher BMI Z-score as the only significant predictor of higher DEPS-R score (β, 1.54; P = 0.016). For children diagnosed ≥13 years of age, the only significant predictor of higher DEPS-R scores was increased weight gain 3 months after diagnosis in women (β, 0.88; P = 0.001).

“These findings suggest that various clinical features, including age at diagnosis and duration of disease, influence the development of disordered eating behavior,” the researchers wrote. . “Therefore, it is imperative to define risk factors for disrupted eating behavior in adolescents with T1D.”

References

  1. Propper-Lewinsohn T, Gillon-Keren M, Shalitin S, et al. Disturbed eating behavior in adolescents with type 1 diabetes may be influenced by weight at diagnosis and subsequent rapid weight gain [published online ahead of print, 2023 Jun 14]. diabetes medicine. 2023; e15166. Doi: 10.1111/dme.15166
  2. Fornasini S, Miele F, Pirus EM. Impact of developing type 1 diabetes on family life. Integrated review. J child femme stud. 2020;29:1467-1483.doi:10.1007/s10826-019-01544

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