Screening for Disordered Eating Behaviors in Adolescents and Young Adults With Type 1 Diabetes

Elizabeth A. Doyle, DNP, APRN, BC-ADM, CDE


Pediatr Nurs. 2016;42(4):197-200. 

In This Article

Abstract and Introduction


The term "disordered eating behavior" (DEB) encompasses many different pathological eating behaviors. Clinical eating disorders as specified in the DSM-V (e.g., anorexia nervosa, bulimia nervosa) (American Psychiatric Association [APA], 2013) are considered DEBs. However, DEB also includes other eating behaviors, such as dieting and/or excessive exercise for weight control, binge eating, and purging behaviors. Although a youth who exhibits these behaviors may not meet the diagnostic criteria for a clinical eating disorder, these actions are still dangerous, particularly in the context of type 1 diabetes. Unfortunately, DEBs, including insulin manipulation to control or lose weight, are common in adolescents with type 1 diabetes (Baechle et al., 2014; Goebel-Fabbri, 2013), and are associated with severe complications of diabetes (Peveler et al., 2005; Takii et al., 2008) and an increased mortality (Goebel-Fabbri et al., 2008).

Because of the dangers inherent with the co-diagnosis of type 1 diabetes and DEB, it is essential that routine screening for DEB in adolescents and young adults occurs during diabetes follow-up and primary care visits. Although this screening is recommended to be done during quarterly endocrine visits for care of the adolescent/young adult with diabetes, it is important for primary care providers (PCPs) to be aware of DEB, including possible insulin manipulation in adolescents with type 1 diabetes, question the adolescent about possible DEB, and work collaboratively with the endocrine team to monitor such behaviors. The PCP can also assist with arranging mental health counseling and education on potential long-term complications associated with DEB.