Does a focus on food increase risk of disordered eating behaviours in teens with type 1 diabetes?

A US study has found a family-based intervention was effective in improving healthy eating in youth with type 1 diabetes, without increasing their risk for disordered eating.

by Dr Christel Hendrieckx

It is often stated that the focus on food and carbohydrate counting as part of diabetes management is a potential risk factor for developing eating disorders. This US study explored whether scores on the Diabetes Eating Problem Survey-Revised (DEPS-R) changed over the course of a behavioural intervention. The aim of this family-based intervention was to improve the quality of diet through face-to-face sessions, promoting intake of healthy food such as fruits, vegetables, whole grains and legumes. Several behavioural techniques were used, including motivational interviewing, educational content, learning activities, applied goal-setting and problem-solving.

Both parent and child nine clinic-based sessions: the first six were monthly and the last three attended booster sessions at months 9, 10 and 15. The data of 90 adolescents (42 in the intervention group and 48 in the control group) were included in this secondary analysis of a randomised clinical trial. On average, adolescents were 14 years old, and had lived with type 1 diabetes for 7 years. Almost two-thirds were using an insulin pump.

There were no differences in DEPS-R scores at any of the time points (baseline, 6, 12 and 18 months) between the intervention and control group, and no change in scores over time within groups. This is good news, because the intervention had previously been shown to be effective in improving overall diet without changing the diabetes outcomes, as reported in the primary outcomes paper. In the conclusions, the authors emphasise the intervention’s positive approach to healthy eating and its benefits, rather than to dietary restrictions and weight-related issues. Also the family-based nature of the intervention may have served as a protective factor. A second relevant finding was the association between the DEPS-R scores and hyperglycaemia (high glucose levels), but not glucose variability. It may be that hyperglycaemia is a better indicator of disordered eating or eating disorders, than glucose variability, but this needs further study.

These findings are encouraging and provide reassurance for health professionals that there is an effective way to support young people in this complex and core aspect of managing type 1 diabetes.

Eisenberg Colman MH, Quick VM, Lipsky LM,1 Dempster KW, Liu A, Laffel LMB, Mehta SN, Nansel TR. Disordered Eating Behaviors Are Not Increased by an Intervention to Improve Diet Quality but Are Associated With Poorer Glycemic Control Among Youth With Type 1 Diabetes. Diabetes Care 2018; 41(4): 869-875.

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