Abstract

 

Objective: This study aimed to evaluate the risk of diabetes-specific eating disorders (EDs) and disease acceptance in adolescents with type 1 diabetes mellitus (T1DM) and to examine their associations with metabolic control and anthropometric measurements.

Material and Methods: A total of 73 adolescent with T1DM (11-19 years) participated. Data were collected face to face using questionnaires on sociodemographic and clinical characteristics, the Diabetes Eating Problem Survey-Revised (DEPS-R), and Acceptance and Action Diabetes Questionnaire (AADQ). Biochemical results and anthropometric measurements were obtained from medical records and direct assessment. Data were analyzed via SPSS and JASP.

Results: Nearly half of the participants (45.2%) were at high risk for diabetes-specific EDs. The mean DEPS-R score was 21.3±12.0, and the mean AADQ score was 47.6±9.7. Skipping main meals was associated with higher DEPS-R scores (p=0.025) and lower AADQ scores (p=0.009). A weak negative correlation was found between HbA1c and AADQ score (r=-0.280, p=0.018).

Conclusion: A considerable proportion of adolescents with T1DM are at high risk for EDs, and poor disease acceptance is linked to worse metabolic control. These findings underscore the importance of routine screening for disordered eating in clinical practice and the potential value of incorporating psychological flexibility-based interventions to improve outcomes.

References

  1. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Fard HH, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promotion Perspectives. 2020;10(2):98. https://doi.org/10.34172/hpp.2020.18
  2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice. 2019;157:107843. https://doi.org/10.1016/j.diabres.2019.107843
  3. Tarçın G, Akman H, Güneş Kaya D, Serdengeçti N, İncetahtacı S, Turan H, et al. Diabetes-specific eating disorder and possible associated psychopathologies in adolescents with type 1 diabetes mellitus. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2023;28(1):36. https://doi.org/10.1007/s40519-023-01559-y
  4. Porcel-Chacón R, Antúnez-Fernández C, Mora Loro M, Ariza-Jimenez A-B, Tapia Ceballos L, Jimenez Hinojosa JM, et al. Good metabolic control in children with type 1 diabetes mellitus: does glycated hemoglobin correlate with interstitial glucose monitoring using FreeStyle Libre? Journal of Clinical Medicine. 2021;10(21):4913. https://doi.org/10.3390/jcm10214913
  5. Małachowska M, Gosławska Z, Rusak E, Jarosz-Chobot P. The role and need for psychological support in the treatment of adolescents and young people suffering from type 1 diabetes. Frontiers in Psychology. 2023;13:945042. https://doi.org/10.3389/fpsyg.2022.945042
  6. Troncone A, Chianese A, Zanfardino A, Cascella C, Confetto S, Piscopo A, et al. Disordered eating behaviors among Italian adolescents with type 1 diabetes: exploring relationships with parents’ eating disorder symptoms, externalizing and internalizing behaviors, and body image problems. Journal of Clinical Psychology in Medical Settings. 2020;27:727-45. https://doi.org/10.1007/s10880-019-09665-9
  7. de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, et al. ISPAD clinical practice consensus guidelines 2022: psychological care of children, adolescents and young adults with diabetes. Pediatric Diabetes. 2022;23(8):1373. https://doi.org/10.1111/pedi.13428
  8. Berlin KS, Keenan ME, Cook JL, Ankney RL, Klages KL, Semenkovich K, et al. Measuring psychological flexibility in youth with type 1 diabetes. Pediatric Diabetes. 2020;21(8):1566-74. https://doi.org/10.1111/pedi.13110
  9. Kim JE. Illness experiences of adolescents with type 1 diabetes. Journal of Diabetes Research. 2022;2022(1):3117253. https://doi.org/10.1155/2022/3117253
  10. Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Journal of Consulting and Clinical Psychology. 2007;75(2):336. https://doi.org/10.1037/0022-006X.75.2.336
  11. Coleman SE, Caswell N. Diabetes and eating disorders: an exploration of ‘Diabulimia’. BMC Psychology. 2020;8:1-7. https://doi.org/10.1186/s40359-020-00468-4
  12. Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, et al. Risk factors for eating disorders: findings from a rapid review. Journal of Eating Disorders. 2023;11(1):8. https://doi.org/10.1186/s40337-022-00717-4
  13. Troncone A, Cascella C, Chianese A, Zanfardino A, Borriello A, Iafusco D. Body image problems in individuals with type 1 diabetes: a review of the literature. Adolescent Research Review. 2022;7(3):459-98. https://doi.org/10.1007/s40894-021-00169-y
  14. Markowitz JT, Butler DA, Volkening LK, Antisdel JE, Anderson BJ, Laffel LM. Brief screening tool for disordered eating in diabetes: internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes. Diabetes Care. 2010;33(3):495-500. https://doi.org/10.2337/dc09-1890
  15. Ercolino G. Characterizing Disordered Eating Behaviors Among Older Adults with Type 1 Diabetes 2024.
  16. Turan H, Kaya DG, Tarçın G, Evliyaoğlu SO, Ercan O. Adölesanlarda diyabete özgü yeme bozukluğu:’Diabulimia’riskinin ve metabolik etkilerinin araştırılması. Ege Tıp Dergisi. 2022;61(1):30-7. https://doi.org/10.19161/etd.1085617
  17. Karadere ME, Yavuz KF, Asafov EY, Küçükler FK. Reliability and validity of a Turkish version of the acceptance and action diabetes questionnaire. Psychiatry Investigation. 2019;16(6):418. https://doi.org/10.30773/pi.2019.02.26.2
  18. de Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatric Diabetes. 2022;23(8):1270. https://doi.org/10.1111/pedi.13455
  19. World Health Organization. WHO anthro survey analyser and other tools. Available from: http://www.whoint/childgrowth/software/en.
  20. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status: University of Michigan Press; 1990. https://doi.org/10.3998/mpub.12198
  21. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. The Journal of Pediatrics. 2004;145(4):439-44. https://doi.org/10.1016/j.jpeds.2004.06.044
  22. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. International Journal of Food Sciences and Nutrition. 2005;56(5):303-7. https://doi.org/10.1080/09637480500195066
  23. Karastogiannidou C, Giannoulaki P, Samaras I, Kotzakioulafi E, Didangelos T, Bocsan IC, et al. The diabetes eating Problem Survey-Revised (DEPS-R) in a greek adult population with type 1 diabetes Mellitus: Model comparison supporting a single factor structure. Nutrients. 2021;13(7):2375. https://doi.org/10.3390/nu13072375
  24. Ryman B, MacIsaac J, Robinson T, Miller MR, Herold Gallego P. Assessing the clinical utility of the diabetes eating problem survey‐revised (DEPS‐R) in adolescents with type 1 diabetes. Endocrinology, Diabetes & Metabolism. 2019;2(3):e00067. https://doi.org/10.1002/edm2.67
  25. Daniel L, Haile D, Egata G. Disordered eating behaviours and body shape dissatisfaction among adolescents with type 1 diabetes: a cross sectional study. Journal of Eating Disorders. 2023;11(1):169. https://doi.org/10.1186/s40337-023-00876-y
  26. Lawrence CM, Smart CE, Fatima A, King BR, Lopez P. Increased bolus overrides and lower time in range: Insights into disordered eating revealed by insulin pump metrics and continuous glucose monitor data in Australian adolescents with type 1 diabetes. Journal of Diabetes and its Complications. 2024;38(12):108904. https://doi.org/10.1016/j.jdiacomp.2024.108904
  27. Nilsson F, Madsen JOB, Jensen AK, Olsen BS, Johannesen J. High prevalence of disordered eating behavior in Danish children and adolescents with type 1 diabetes. Pediatric Diabetes. 2020;21(6):1043-9. https://doi.org/10.1111/pedi.13043
  28. Polat Ö, Yılmaz S, Çakır EP. Tip 1 Diyabetik Ergenlerde Yeme Bozukluklarının Sıklığı ve İlişkili Faktörler. Medical Journal of Bakirkoy. 2023.
  29. Harm M, Hope M, Household A. American psychiatric association, 2013, diagnostic and statistical manual of mental disorders, 5th edn, washington, dc: American psychiatric association anderson, j, sapey, b, spandler, h (eds.), 2012, distress or disability?, lancaster: Centre for disability research. Arya. 2013;347:64. https://doi.org/10.1176/appi.books.9780890425596
  30. Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, et al. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta‐analysis. Diabetic Medicine. 2013;30(2):189-98. https://doi.org/10.1111/j.1464-5491.2012.03771.x
  31. Gonçalves S, Barros V, Gomes AR. Eating-disordered behaviour in adolescents with type 1 diabetes. Canadian Journal of Diabetes. 2016;40(2):152-7. https://doi.org/10.1016/j.jcjd.2015.09.011
  32. Wijk I, Amsberg S, Johansson U-B, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ Open. 2023;13(12):e072061. https://doi.org/10.1136/bmjopen-2023-072061
  33. Saito J, Shoji W, Kumano H. The reliability and validity for Japanese type 2 diabetes patients of the Japanese version of the acceptance and action diabetes questionnaire. BioPsychoSocial Medicine. 2018;12:1-7. https://doi.org/10.1186/s13030-018-0129-9
  34. O’Connell MA, Northam EA, Brown A, Papoutsis J, Schuster T, Skinner T, et al. Does insulin pump therapy offer benefits for behaviour, mood, cognition and HbA1c in children and adolescents with type 1 diabetes? A randomised controlled trial with observational follow-up. Archives of Disease in Childhood. 2024;109(10):806-11. https://doi.org/10.1136/archdischild-2023-326007
  35. Vesco AT, Jedraszko AM, Garza KP, Weissberg-Benchell J. Continuous glucose monitoring associated with less diabetes-specific emotional distress and lower A1c among adolescents with type 1 diabetes. Journal of Diabetes Science and Technology. 2018;12(4):792-9. https://doi.org/10.1177/1932296818766381
  36. Kaushik A, Rekhi TK, Puri S, Tandon N. Nutritional Guidelines for Patients with Type 1 Diabetes Mellitus and its Adherence-A Narrative Review. Indian Journal of Endocrinology and Metabolism. 2024;28(5):461-9. https://doi.org/10.4103/ijem.ijem_104_24
  37. Jaworski M, Panczyk M, Cedro M, Kucharska A. Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator. Patient Preference and Adherence. 2018:163-74. https://doi.org/10.2147/PPA.S147233

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Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Aslan Ceylan J, Bayındır Gümüş A. Diabetes-specific eating disorder and psychological flexibility in adolescents with type 1 diabetes: Impact on metabolic control and anthropometric measurements. Turk J Pediatr Dis. 2025;Early View:1-9. https://doi.org/10.12956/TJPD.2025.1126