PracticeUpdate Diabetes March 2019

EXPERT OPINION 20

Disordered Eating Behaviors in Adolescents With Type 1 Diabetes By Elizabeth A. Doyle DNP, APRN, BC-ADM, CDE Ms. Doyle is an Assistant Professor in the Pediatric Nurse Practitioner specialty, Yale Diabetes Center at Yale New Haven Hospital in New Haven Connecticut, and Lecturer at Yale School of Nursing in Orange, Connecticut.

Cecilia-Costa and colleagues conducted a cross-sectional study designed to assess the occurrence of disordered eating behaviors (DEB) in adolescents with type 1 diabetes. 1 Furthermore, they examined characteristics of the participants at each level of DEB (low, moderate, high) to help provide insight as to which characteristics in teenagers might place them more at risk for these dangerous behaviors. T he convenience sample consisted of 178 adolescents (48% girls), aged 13 to 17 years, with type 1 diabetes for an average duration examine characteristics in the sample at the three different levels of DEB.

Results of the study showed that 59% of the sample had low levels of DEB, whereas 26% had moderate and 15% had high levels of DEB. The moderate and high groups had a greater percentage of girls and a greater percentage of obese teenagers. With higher levels of DEB, there was less treatment adherence, along with higher A1c levels, and the frequency of daily glucose monitoring decreased. Furthermore, poorer quality of life, more depressive symptoms, and more diabetes-specific family conflict were associated with higher levels of DEB. Multiple previous studies have shown that DEB are associated with poor metabolic control. In fact, one 11-year follow-up study demonstrated that women with type 1 diabetes who reported intentionally underdosing or omitting their insulin had a threefold higher relative risk of mortality during this follow-up period compared with those who did not report these behaviors at baseline. 3 Thus, it is not surpris- ing that, in their most recent practice guidelines, the American Diabetes Association recommends screening for DEB in youth with type 1 diabetes beginning at the age of 10–12 years. 4 The findings from this specific study suggests that adolescents who are female, in poorer metabolic

of 14.9±1.3 years. After consent from parents was obtained, metabolic and treatment data were collected by chart review and direct interview with the patient/parent, and many psychosocial surveys were completed, including the Diabetes Eating Problem Survey-Revised (DEPS-R). This is a Likert scale assessing general and diabetes- specific DEB, where higher scores indicate more DEB. The validated cut-off score of ≥20 indicates a higher number and frequency of DEB, warranting further evaluation. 2 For the purpose of this paper, the authors divided their sample into three categories for DEB – “low” meaning a score <10, “moderate” 10–19, and “high,” a DEPS-R score ≥20. Descriptive statistics were used to describe the sample, and appropriate bivariate analyses were done to

" …adolescents who are female, in poorer metabolic control, obese, and with poor treatment adherence, along with those with more depressive symptoms

and poorer quality of life may especially need closer attention, as youth in this study with these behaviors had higher levels of DEB. "

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