Eating disorders common in youngsters with T1D and T2D

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Youth and young adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) commonly have disordered eating behaviors (DEBs), according to a new study reported June 12 at the 77th Scientific Sessions of the American Diabetes Association in San Diego.

"DEB is common in patients with diabetes. More than 20% of T1D and even up to 50% of T2D had concerns about DEB. We were surprised that even young children between 10 and 14 years of age already showed some signs of disordered eating behaviors. Participants with DEB also had lower insulin sensitivity," lead author Dr. Angel Siu-Ying Nip of the University of Washington in Seattle told Reuters Health.

"Patients with diabetes are at risk of developing disordered or maladaptive behaviors to lose weight. However, as health care providers do not usually start screening at early ages, the problem is under-recognized. We recommend screening DEB starting at early adolescence," Dr. Nip advised in an email.

As part of the SEARCH study for diabetes in youth, Dr. Nip and her co-authors evaluated youth and young adults with T1D or T2D who had been diagnosed since 2002 in South Carolina, Ohio, Colorado, California, or Washington. The participants were at least 10 years old.

Overall, there were 2,156 participants with TD1 (mean age 17.7) and 161 with TD2 (mean age 21.8). Both groups had had diabetes for around 8 years. Between 2011 and 2015, everyone in the study completed the Diabetes Eating Problem Survey - Revised (DEPS-R), which contains 16 diabetes-specific questions about eating behavior. A score of 20 or higher indicated DEB.

The researchers found DEPS-R scores of 20 or above in 21.2% of patients who had T1D and in 52.2% of those who had T2D.

Higher DEPS-R scores were associated with higher body mass index (BMI) z-scores (p<0.01 for both groups), and lower insulin sensitivity (p<0.01 for both groups), as well as higher HbA1c (p<0.01 for T1D; p=0.01 for T2D), higher depression scores (p<0.01 for both) and poorer pediatric quality-of-life scores (p<0.01 for both).

Overall, 31.5% of the young people with T1D and 60.3% of those with T2D said in the survey that keeping their weight healthy while controlling diabetes was a challenge; 19.1% with T1D and 34.8% with T2D were concerned that their eating is out of control; 12.4% with T1D and 34.2% with T2D expressed a desire to be thin even if it compromised their diabetes control; and 27.5% with T1D and 50.3% with T2D reported binge eating. Also, 18.2% of participants with T1D skipped taking insulin.

Patients with DEB also had poorer health outcomes, including worse glycemic control, more depressive symptoms and worse quality of life.

Dr. Nip told Reuters Health that a strength of the study is that it is part of the SEARCH nationwide population based study of childhood diabetes. "We had a large sample size, especially for type 1 diabetes," she said.

But she also mentioned limitations to the study, including the relatively small sample size for type 2 diabetes.

"DEB is common among youth and young adults and is associated with significant adverse health consequences, yet it is underrecognized. We should start screening at early age in the clinic and develop collaborative and effective interventions for our patients with DEB," Dr. Nip advised.

Coauthor Dr. Catherine Pihoker, also of the University of Washington in Seattle, said in an email, "The population-based SEARCH study has been underway since 2001. Participants are well-characterized in terms of diabetes type, treatment regimen, and study measures - including insulin sensitivity, acute and chronic complications and risk factors for complications."

Dr. Pihoker joined Dr. Nip in recommending early eating behavior assessment. "Given the associations of disordered eating and diabetes outcomes, it is important to assess eating behaviors in youth with type 2 diabetes as well as in those with type 1 diabetes," she said.

The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention and supported by the National Institute of Diabetes and Digestive and Kidney Diseases.


American Diabetes Association 2017.

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