Eating behaviours of adolescents with type 1 diabetes. Does gender matter?

Another paper of the Diabetes Miles Youth – Australia study has recently been published.

by Dr Christel Hendrieckx

This paper reports the results of the first Australian study on prevalence of problematic eating behaviours and body dissatisfaction in a national sample of adolescents with type 1 diabetes using diabetes-specific and gender-specific measures. Participants in the Diabetes MILES Youth between the age of 13 and 19 years (N=477) completed the Diabetes Eating Problem Survey -Revised (DEPS-R) and the Body Mass Index Silhouette Matching Test (BMI-SMT).

Females had higher scores on the DEPS-R than males, with scores for females increasing with age. Another difference for gender was that 50% of female and 18% of male adolescents scored above the DEPS-R cut-off. This cut-off has been defined as a greater risk for problematic eating behaviours. Self-reported BMI, HbA1c, insulin omission, and binge eating frequency were associated moderately with DEPS-R for both genders. This is a novel and important finding demonstrating that male adolescents with type 1 diabetes are also impacted by problematic eating behaviours, and adds to the paucity of research into this understudied subgroup.

Only 10% of females and 24% of males were satisfied with their actual body size. For those who were dissatisfied there was a difference in gender. 88% of the females and 43% of the males expressed a desire to be thinner; while 33% of males and 2% of the females desired a larger body size. Body dissatisfaction and DEPS-R were positively associated for both genders. The adolescents were also asked to indicate the size they believed they would be without diabetes. 59% of females and 38% of males believed they would be bigger than their ideal size without diabetes; 25% of females and 39% of males believed they would be at their ideal size if they did not have type 1 diabetes.

Our study provided support for the DEPS-R to be a useful screening tool for identifying problematic eating behaviours as well as potential body image issues, among female adolescents with type 1 diabetes. However, for the majority of male adolescents, specific items within the DEPS-R may require modification or additional items to better capture their desire to be more muscular. Further, we believe that elevated DEPS-R scores provide an indication that the adolescent experiences difficulties in combining management of their diabetes, weight and healthy eating. Consequently, individuals with high DEPS-R scores warrant attention, and may require additional support with their diabetes management and/or are potentially at risk of developing an eating disorder.

Araia E, Hendrieckx C, Skinner T, Pouwer F, Speight J, King RM. Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from Diabetes MILES Youth—Australia. International Journal of Eating Disorders, 2017, DOI: 10.1002/eat.22746

Clinically-meaningful cut-points for diabetes distress among adolescents with type 1 diabetes

A new publication from the ACBRD highlights the high proportion of adolescents with type 1 diabetes who experience clinically-significant diabetes distress.

by Virginia Hagger

Studies in adults have reported high levels of emotional distress related to living with type 1 and type 2 diabetes. Diabetes distress characterises the ongoing emotional burden of managing diabetes, including feelings of frustration, worry and helplessness. The prevalence of diabetes distress among adolescents was previously uncertain, due to the absence of validated cut-points for age-appropriate measures.

This study by ACBRD researchers Virginia Hagger, Dr Christel Hendrieckx, Prof Jane Speight, and colleagues recently published in Diabetes Care, included 537 adolescents aged 13 to 19 years, who took part in the national Diabetes MILES Youth survey. Diabetes distress was measured with the Problem Areas in Diabetes-Teen (PAID-T), a brief questionnaire reflecting diabetes-related concerns specific to adolescents’ age and life-stage. The relationships between the PAID-T and depressive symptoms, self-reported HbA1c and self-monitoring of blood glucose (SMBG), were examined in order to establish clinically meaningful cut-points for diabetes distress.

Two cut-points were found to distinguish between three levels of severity: none-to-mild (<70), moderate (70–90), and high (>90) diabetes distress. Over half of the adolescents reported at least moderate distress (18% moderate; 36% high distress). Compared to adolescents with none-to-minimal distress, those with greater distress had significantly higher self-reported HbA1c and more severe depressive symptoms, and performed SMBG less frequently.

Using these cut-points, clinicians and researchers will now be able to identify young people who could potentially benefit from self-management support and enable evaluation of interventions aimed at reducing diabetes distress.

Hagger V, Hendreickx C, Cameron F, Pouwer F,  Skinner T, Speight J. Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-Teen: Results From Diabetes MILES Youth–Australia. Diabetes Care;

The Diabetes MILES Youth Study was funded by the National Diabetes Services Scheme, an initiative of the Australian Government, administered with the support of Diabetes Australia.