Disordered eating common for adolescents with type 1 diabetes using an insulin pump
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Key takeaways:
- Providers should screen for disordered eating behaviors among adolescents with type 1 diabetes using an insulin pump.
- Switching to a hybrid closed-loop system could help reduce HbA1c levels for adolescents.
Disordered eating behaviors were reported by 42.5% of adolescents with type 1 diabetes who currently use or previously used an insulin pump, according to findings published in Diabetes Technology & Therapeutics.
“Our findings suggest that regular screening for disordered eating behaviors and risk factors for disordered eating behaviors are essential and may have implications on the persistence of pump therapy and achieving lower HbA1c,” Tamar Propper-Lewinsohn, of the Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes at Schneider Children’s Medical Center of Israel, and colleagues wrote. “Additionally, adolescents and young adults with disordered eating behaviors who are treated with insulin pumps may benefit by changing to a hybrid closed-loop system, which may reduce their HbA1c levels.”
Researchers conducted an observational study of participants aged 13 to 21 years with type 1 diabetes for at least 6 months who were using an insulin pump for at least 3 months or previously used an insulin pump in the past. Recruitment took place from October 2022 to July 2023. Sociodemographic data, HbA1c, insulin pump duration, use of continuous glucose monitoring and current insulin regimen were collected from medical records. The Diabetes Eating Problem Survey – Revised was administered to assess disordered eating behaviors. A score of 20 or higher indicated an increased risk for disordered eating. Participants completed the Problem Areas in Diabetes Survey – Pediatric Version, a six-item dietary regimen questionnaire and a questionnaire assessing disinhibited eating.
There were 167 adolescents and young adults who completed the study (50.3% female). Of the study group participants, 42.5% were at high risk for disordered eating behaviors. Females had a higher disordered eating behaviors score than males (22.72 vs. 15.25; P < .001). An HbA1c level of less than 7% was achieved by 24.2% of participants. Of the study group participants, 87.4% were using insulin pumps at the time of the study and 21.9% of insulin pump users were using a hybrid closed-loop system.
In linear regression analysis, female sex, higher BMI z score, shorter diabetes duration, higher HbA1c, longer duration of insulin pump use, insulin pump discontinuation, higher Problem Areas in Diabetes Survey score and higher disinhibited eating score were associated with a higher score for disordered eating behaviors.
Among participants without disordered eating behaviors, those using a hybrid closed-loop system were more likely to have a higher BMI z score (OR = 3.46; 95% CI, 1.52-7.87; P = .003) than insulin pump users. Among young people with disordered eating behaviors, those using a hybrid closed-loop system were more likely to have a lower HbA1c (OR = 0.29; 95% CI, 0.1-0.83; P = .022) and a higher socioeconomic status (OR = 1.73; 95% CI, 1.09-2.74; P = .02) than people using an insulin pump.
“The association between hybrid closed-loop systems use and higher socioeconomic status was found only among adolescents and young adults with disordered eating behaviors,” the researchers wrote. “In previous studies, it was found that higher socioeconomic status was associated with a better uptake of technology use. Further studies with a larger population are needed to examine these associations.”
Perspective
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Disordered eating among people with diabetes is associated with increased difficulty with diabetes management as well as increased risk for diabetic ketoacidosis, hospitalization, retinopathy and neuropathy, so research helping us understand this intersection is incredibly important.
One of the factors associated with higher risk for disordered eating in this study was a higher BMI z score. Clinicians can use these data to reinforce the importance of taking extra caution when discussing weight with their young patients and families with type 1 diabetes. Asking permission to discuss weight and focusing on behaviors rather than numbers on the scale are key.
This study also found that disordered eating behaviors are associated with a higher HbA1c, and those on a hybrid closed-loop insulin pump have a lower HbA1c. The authors recommend switching patients to a hybrid closed-loop pump to reduce HbA1c. There are other tools available to clinicians to improve outcomes in addition to this recommendation. Eating disorder research has found that using neutral language about food and weight during patient interactions is critical to both prevention and treatment of eating disorders. A key feature of neutral language is avoiding labeling foods as good or bad — statements like “try to focus on high quality carbohydrates” or “eat mostly clean foods” insinuate that there are good and bad foods. Instead, try “this food has X grams of carbohydrates.” We also recommend using neutrality when discussing blood glucose numbers, such as “your average blood sugar was XYZ” rather than “your blood sugar was high.”
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