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

Grant success for the ACBRD!

Dr Adriana Ventura and team will take the Diabetes and Emotional Health handbook to the ‘next level’ thanks to funding secured through the ADEA Diabetes Research Foundation.

We are delighted that a project grant submitted to the Australian Diabetes Educators Association (ADEA) Diabetes Research Foundation has been successful. Led by Dr Adriana Ventura and Dr Christel Hendrieckx, the project is titled ‘Supporting people with diabetes distress: Development and pilot randomised controlled trial of an online training module for health professionals’.

 The objective of the project is to deliver a practical, evidence-based online training module to support health professionals to identify and address diabetes distress in adults with type 1 or type 2 diabetes. The content of the module will be based on previous work on the Diabetes and Emotional Health handbook, taking this already high-quality resource to the next level.  A randomised controlled trial will provide important evidence for the effectiveness of the online training module for improving health professional knowledge, motivation and confidence to identify and address diabetes distress in clinical practice.

Once a fully functioning and pilot tested training module is available, the ACBRD plans to offer the module to ADEA members as a tool for continuing professional development (CPD).  The online training module is expected to significantly increase health professionals’ ability to manage emotional health issues in clinical practice.

Measuring stigma associated with Type 1 Diabetes

A new paper from the ACBRD describes development of the DSAS-1 questionnaire. 

by Dr Adriana Ventura

The ACBRD recognises that stigma is perceived and experienced by people with diabetes, and that we need to be able to quantify this so that we can better understand stigma and its relationship with emotional well-being, self-care and clinical outcomes.

In 2014, the ACBRD conducted a qualitative study, interviewing 27 adults with type 1 diabetes (T1DM) about the ‘social experience’ of living with T1DM. We found that stigmatisation is part of the social experience of living with T1DM. That is, adults with T1DM were able to tell us about their perceptions (and experiences) of being negatively judged, stereotyped or blamed for having diabetes. The consequence of this stigma was feeling distressed and isolated, and in some circumstances, delaying or avoiding diabetes self-management tasks (e.g. checking glucose, injecting insulin in public). These personal accounts are really powerful but, until now, there has been no way of measuring the extent to which the wider population of adults with T1DM perceives and experiences diabetes-related stigma. This is due to a lack of validated questionnaires.

Thus, the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) was conceived.

The DSAS-1 was rigorously developed by Dr Jessica Browne and colleagues, and involved input from adults with T1DM to not only test the items, but to ensure the words we used made sense and were relevant for people with T1DM.  A large sample of adults with T1DM (N=898) then completed the items in an online survey. Psychometric analyses were used to examine whether the individual items would combine into a ‘scale’. What resulted was a 19-item scale assessing three distinct but related factors: ‘Treated Differently’, ‘Blame and Judgement’ and ‘Identity Concerns’.

The DSAS-1 is a valid and reliable measure, with satisfactory psychometric properties. It is now available to researchers and clinicians to enable quantitative measurement of the extent and impact of the perceptions and experiences of T1DM stigma.

We have developed a similar scale for type 2 diabetes (the DSAS-2), which was published in Dec 2017, and you can read about it here.

If you would like to use the DSAS-1 or DSAS-2 in your research or clinical practice, please email to enquire about or access the latest version of the questionnaires and scoring guidance.

Browne J, Ventura A, Mosely K, Speight J. Measuring Type 1 diabetes stigma: development and validation of the Type 1 Diabetes Stigma Assessment Scale (DSAS-1). Diabetic Medicine, 2017; doi: 10.1111/dme.13507.

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.

Have ‘your SAY’ on diabetes and quality of life

Research opportunity: Adults with type 1 or type 2 diabetes invited to take part in online survey.

by Dr Elizabeth Holmes-Truscott

The landscape of diabetes treatments, technologies and education programs is forever changing and growing, but is united in the goal to improve the lives of people with diabetes. We believe that it is essential to evaluate the impact of existing and novel diabetes treatment, technology and programs, on quality of life, not only medical outcomes.

Quality of life cannot be assessed with blood or other medical tests. Quality of life is subjective – it is only truly known by the individual – so it is not even appropriate to ask a health professional to provide a ‘proxy’ assessment of a person’s quality of life. Quality of life means different things to different people, at different times. There are now many questionnaires available to assess the impact of diabetes on quality of life. This is where we need your help! We think its important for people with diabetes to tell us, researchers, which are the best questionnaire(s) from your perspective – which are most relevant, easy to understand, easy to complete, etc,.

We invite English-speaking adults (18-75 years old) with type 1 or type 2 diabetes to complete the  ‘Your SAY (Self-management And You): Quality of Life’ online survey.

In order to have an opinion, we ask that you complete several quality of life questionnaires and then give your feedback on what you like or don’t like about each one. We know the survey is quite long and the questions do seem repetitive but it is important to pitch these questions against each other to understand which ones work best for which purpose. The findings of the survey will assist researchers and health professionals in choosing the ‘best’ measure of quality of life for people with diabetes.

We very much hope you will get involved, and have Your SAY by completing the online survey.

The Your SAY study is being conducted by the ACBRD, University of Sheffield and University of Surrey and is a sub-study of DAFNEplus (Dose Adjustment for Normal Eating). The findings of the Your SAY study will inform questionnaire selection for DAFNE