Norra MacReady

June 10, 2017

SAN DIEGO — More than half of young patients with type 2 diabetes said they engage in disordered eating behaviors, such as bingeing and vomiting, the findings of a new study show.

And among young people with type 1 diabetes, more than 20% reported these behaviors.

Dr Angel Siu Ying Nip

Those who admitted disordered eating also were more likely to experience depressive symptoms and poorer quality of life, lead author Angel Siu Ying Nip, MD, a fellow in pediatric endocrinology at the University of Washington, Seattle, said during a press conference here at the American Diabetes Association (ADA) 2017 Scientific Sessions.

She recommends regular screening for disordered eating among young patients with diabetes and intervention as early as possible when problems arise.

The findings reflect the toll taken by the intense focus on diet and weight required by diabetes management, said Dr Nip.

Indeed, the "food-focused" nature of diabetes management may  "lend itself to issues around controlling food and insulin intake," said Alicia McAuliffe Fogarty, PhD, vice president of the lifestyle management team at the American Diabetes Association, who moderated the press conference but was not involved in this research.

Dr Alicia McAuliffe Fogarty

Given the association between disordered eating and depression, early identification is key so patients can receive psychosocial support, Dr McAuliffe Fogarty stressed.

"If you can provide them with support and education on managing their diabetes more effectively, you can prevent someone from developing significant psychological issues."

More Than Half of Youth With Type 2 Diabetes Have Disordered Eating Behavior

For their study, Dr Nip and coauthors examined the prevalence of disordered eating in youth and young adults with diabetes and identified some of the associated characteristics.

They used data from SEARCH for Diabetes in Youth, an ongoing cohort surveillance study started in 2002, which assesses diabetes prevalence in the pediatric population in five states: South Carolina, Ohio, Colorado, Washington, and California. It is considered the largest and most comprehensive study of its kind to date in the United States.

For this analysis, Dr Nip and her colleagues identified 2156 participants with type 1 diabetes and 161 with type 2 diabetes. The patients were 10 years of age or older, had participated in cohort visits between 2011 and 2015, and had completed the Diabetes Eating Problem Survey-Revised (DEPS-R) screening tool. Scores of 20 or more, considered evidence of disordered eating behaviors, were seen in 21.2% of the patients with type 1 diabetes and 52.5% of patients with type 2 diabetes.

Patients with type 1 diabetes had an average age of 17.9 years. Compared with those with DEPS-R scores less than 20, participants with DEPS-R scores of 20 or more were more likely to be female; to have a higher body mass index (BMI), lower insulin sensitivity, higher HbA1c levels; and to have experienced diabetic ketoacidosis within the previous 6 months. They also scored higher on the Center for Epidemiologic Studies Depression Scale (CES-D) and lower on measures of pediatric quality of life (< .0001 for all comparisons).

The average age of patients with type 2 diabetes was 21.9 years. For them, DEPS-R scores of 20 or more were associated with higher BMI (= .0004), lower insulin sensitivity (< .0001), and higher HbA1c (= .0177). As with the type 1 diabetes patients, they also scored higher on the test for depression and lower on the rating of pediatric quality of life (< .0001 for both).

Common, Underrecognized Problem: Start Screening Early

These findings suggest that disordered eating among younger diabetes patients is "a common problem, yet underrecognized and underdetermined," Dr Nip stressed.

"We recommend screening for disordered eating behavior starting in early adolescence," she reiterated.

And the emphasis on controlling food and weight may itself be a risk factor, she noted.

"The way we explain it to kids and their parents now, with the focus and preoccupation with food choices and limiting what they eat, could actually make the patients prone to developing some inappropriate eating behaviors to lose weight.

"They also are struggling with self-esteem issues over having a chronic disease and may be vulnerable to mood disorders or other psychiatric problems. So these may all be risk factors for developing disordered eating."

The DEPS-R is a good screening tool that can easily be administered in a clinician's office, Dr Nip explained.

It consists of 16 questions that asks patients how they feel about their diet and whether they engage in any inappropriate behaviors, such as skipping insulin or eating less in an attempt to lose weight.

"We also recommend looking for red flags such as unintentional weight gain or weight loss or an abrupt worsening of HbA1c. This might give us a hint that there may be some issues occurring around food."

The American Diabetes Association has developed, with the American Psychological Association, a Mental Health Provider Diabetes Education Program designed to increase the number of mental-health professionals who can help patients cope with the psychosocial issues associated with diabetes.

Neither Dr Nip and coauthors nor Dr McAuliffe Fogarty disclosed any relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook .

American Diabetes Association 2017 Scientific Sessions. June 10, 2017; San Diego, California. Abstract 802-P


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: