Adolescent patients with type 1 diabetes (T1D) and disordered eating behavior (DEB) who treated their T1D with a basal-bolus regimen had inferior outcomes compared with those on a continuous-subcutaneous insulin infusion (CSII), according to investigators from the Pediatric Diabetes Clinic, Pediatric Hospital, Ain Shams University, in Egypt.
In particular, metabolic control was worse and diabetes-related complications were more frequently seen among the basal-bolus cohort with DEB compared with the CSII cohort with DEB. Depression, poor glycemic control, poor body image, and long diabetes duration also had correlations to the severity and frequency of DEB among these patients.
Findings were published earlier this month in Journal of Eating Disorders. Sixty adolescents, with a mean (SD) age of 13.35 (3.28) years and a median (IQR) hemoglobin A1C (HbA1C) of 8.49% (6.6%-13.5%), were included in their final analysis; all had to have at least 1 year of daily insulin treatment via CSII or a basal-bolus regimen. Most (58.3%) were female.
“DEB represents a significant comorbidity among people with T1D, and multiple risk factors are associated with DEB in adolescents with T1D. Treatment modalities of T1D may also influence DEB,” the authors wrote. “Conventional eating disorder therapies are less effective for people with T1D. This highlights the importance of identifying the unique risk determinants for DEB among adolescents with T1D in order to develop effective interventional modalities for them.”
Arabic versions were used for the family history of psychiatric illness assessment, which incorporated the 9-item patient health questionnaire (PHQ-9; score scale: 5 to ≥ 20 [mild to severe depression]); the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), which evaluated depression; the binge eating scale (BES; score scale: ≤ 17 to > 27 [none to severe]), which assessed DEB; and for a 34-item questionnaire, which estimated body distortion (score scale: < 112 to > 140 [more body dissatisfaction to more body satisfaction]).
DEB was evident in 10% of the overall study population, and 36.7% were shown to have depression. Close to a quarter (23.3%) had poor body image and 70%, moderate body perception. Just 6.7% had a good body perception. The median BES ranged from 0 to 22, and the median body image score was 121.5.
Regarding the connection between DEB, CSII, and basal-bolus use, significantly lower results—indicating better outcomes—were evident among those using CSII vs basal-bolus for BES (P = .022), MINI-KID (P = .001), and the PHQ-9 (P = .02). DEB also occurred at a significantly lower rate in the CSII group (P = .009).
Further, when comparing those with T1D who did or did not have DEB, lower incidence of DEB was seen among those with no family history of psychiatric disease (P = .008), no smoking history (P = .008), shorter diabetes duration (P = .028), lower HbA1C (P = .038), and better body image (P = .003). Significant relationship were not seen for either gender (P = .019) or socioeconomic status (P = .634) and DEB.
BES had positive correlations with PHQ9 scores (P < .001), HbA1C (P = .013), and diabetes duration (P = .009), but a negative correlation with body image (P = .003).
The authors noted that because adolescence and diabetes are considered risk factors for DEB, adolescents with T1D are considered particularly vulnerable to DEB. In addition, having the 2 diseases as comorbid conditions can “dramatically increase the rates of morbidity and mortality,” they wrote.
A possible reason for this relationship include the cumulative effects of lifelong insulin therapy, weight gain during puberty, food preoccupation, low self-esteem, and depression.
They also attribute the lower incidence of DEB among adolescents using CSII vs a basal-bolus regimen to greater flexibility with managing their diabetes, less weight gain from reduced daily insulin need, and better glycemic control.
“CSII could be a promising treatment modality for adolescents with T1D having DEB,” the authors concluded. “Further larger longitudinal studies are needed to verify the practical utility of CSII and the role of continuous glucose monitoring in the management of DEB among those with T1D.”
Salah NY, Hashim MA, Abdeen MSE. Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control. J Eat Disord. Published online April 4, 2022. doi:10.1186/s40337-022-00571-4