Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Measures
2.2. Disordered Eating Behavior (DEB)
2.3. Statistical Analysis
3. Results
3.1. Clinical and Anthropometric Characteristics
3.2. Disordered Eating Behaviors
3.3. Insulin Restriction
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Gregory, G.A.; Robinson, T.I.G.; Linklater, S.E.; Wang, F.; Colagiuri, S.; de Beaufort, C.; Donaghue, K.C.; Magliano, D.J.; Maniam, J.; Orchard, T.J.; et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: A modelling study. Lancet Diabetes Endocrinol. 2022, 10, 741–760. [Google Scholar] [CrossRef] [PubMed]
- American Diabetes Association. Introduction: Standards of Medical Care in Diabetes—2022. Diabetes Care 2021, 45, S1–S2. [Google Scholar] [CrossRef]
- Pinhas-Hamiel, O.; Hamiel, U.; Levy-Shraga, Y. Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment. World J. Diabetes 2015, 6, 517–526. [Google Scholar] [CrossRef] [PubMed]
- Young, V.; Eiser, C.; Johnson, B.; Brierley, S.; Epton, T.; Elliott, J.; Heller, S. Eating problems in adolescents with Type 1 diabetes: A systematic review with meta-analysis. Diabet. Med. 2013, 30, 189–198. [Google Scholar] [CrossRef] [PubMed]
- Borus, J.S.; Laffel, L. Adherence challenges in the management of type 1 diabetes in adolescents: Prevention and intervention. Curr. Opin. Pediatr. 2010, 22, 405–411. [Google Scholar] [CrossRef]
- Rydall, A.C.; Rodin, G.M.; Olmsted, M.P.; Devenyi, R.G.; Daneman, D. Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N. Engl. J. Med. 1997, 336, 1849–1854. [Google Scholar] [CrossRef] [PubMed]
- Hanlan, M.E.; Griffith, J.; Patel, N.; Jaser, S.S. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr. Diabetes Rep. 2013, 13, 909–916. [Google Scholar] [CrossRef]
- Markowitz, J.T.; Butler, D.A.; Volkening, L.K.; Antisdel, J.E.; Anderson, B.J.; Laffel, L.M. Brief screening tool for disordered eating in diabetes: Internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes. Diabetes Care 2010, 33, 495–500. [Google Scholar] [CrossRef]
- Pursey, K.M.; Hart, M.; Jenkins, L.; McEvoy, M.; Smart, C.E. Screening and identification of disordered eating in people with type 1 diabetes: A systematic review. J. Diabetes Complicat. 2020, 34, 107522. [Google Scholar] [CrossRef]
- International Diabetes Federation. IDF Diabetes Atlas, 10th ed.; International Diabetes Federation: Brussels, Belgium, 2021. [Google Scholar]
- Robert, A.A.; Al-Dawish, A.; Mujammami, M.; Dawish, M.A.A. Type 1 Diabetes Mellitus in Saudi Arabia: A Soaring Epidemic. Int. J. Pediatr. 2018, 2018, 9408370. [Google Scholar] [CrossRef]
- Al Zahrani, A.M.; Al Shaikh, A. Glycemic Control in Children and Youth With Type 1 Diabetes Mellitus in Saudi Arabia. Clin. Med. Insights Endocrinol. Diabetes 2019, 12, 1179551418825159. [Google Scholar] [CrossRef] [PubMed]
- Al-Qahtani, S.M.; Shati, A.A.; Alqahtani, Y.A.; AlAsmari, A.A.; Almahdi, M.A.; Al Hassan, A.A.; Alhassany, A.M.; Shathan, R.A.; Aldosari, R.M.; AlQahtani, A.S.; et al. Factors Affecting Glycemic Control among Saudi Children with Type 1 Diabetes Mellitus in Aseer Region, Southwestern Saudi Arabia. Int. J. Environ. Res. Public Health 2022, 19, 11558. [Google Scholar] [CrossRef]
- Meltzer, L.J.; Johnson, S.B.; Prine, J.M.; Banks, R.A.; Desrosiers, P.M.; Silverstein, J.H. Disordered eating, body mass, and glycemic control in adolescents with type 1 diabetes. Diabetes Care 2001, 24, 678–682. [Google Scholar] [CrossRef] [PubMed]
- Jawed, A.; Harrison, A.; Dimitriou, D. The Presentation of Eating Disorders in Saudi Arabia. Front. Psychol. 2020, 11, 586706. [Google Scholar] [CrossRef]
- Hummadi, A.; Yafei, S.; Badedi, M.; Abutaleb, R.; Darraj, H.; Alhagawy, A.J.; Khawaji, A.; Solan, Y.; Alzughbi, T.; Hakami, M.; et al. Validation of the Arabic Version of Diabetes Eating Problem Survey–Revised (DEPS-R) among Adolescents with Type 1 Diabetes. Nutrients 2023, 15, 561. [Google Scholar]
- Troncone, A.; Affuso, G.; Cascella, C.; Chianese, A.; Pizzini, B.; Zanfardino, A.; Iafusco, D.; Diabetes Study Group of Italian Society of Paediatric Endocrinology and Diabetology. Prevalence of disordered eating behaviors in adolescents with type 1 diabetes: Results of multicenter Italian nationwide study. Int. J. Eat. Disord. 2022, 55, 1108–1119. [Google Scholar] [CrossRef]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences; Routledge: New York, NY, USA, 2013. [Google Scholar]
- Neumark-Sztainer, D.; Wall, M.; Larson, N.I.; Eisenberg, M.E.; Loth, K. Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. J. Am. Diet. Assoc. 2011, 111, 1004–1011. [Google Scholar] [CrossRef]
- Wisting, L.; Frøisland, D.H.; Skrivarhaug, T.; Dahl-Jørgensen, K.; Rø, O. Disturbed eating behavior and omission of insulin in adolescents receiving intensified insulin treatment: A nationwide population-based study. Diabetes Care 2013, 36, 3382–3387. [Google Scholar] [CrossRef]
- Cherubini, V.; Skrami, E.; Iannilli, A.; Cesaretti, A.; Paparusso, A.M.; Alessandrelli, M.C.; Carle, F.; Ferrito, L.; Gesuita, R. Disordered eating behaviors in adolescents with type 1 diabetes: A cross-sectional population-based study in Italy. Int. J. Eat. Disord. 2018, 51, 890–898. [Google Scholar] [CrossRef]
- Nip, A.S.Y.; Reboussin, B.A.; Dabelea, D.; Bellatorre, A.; Mayer-Davis, E.J.; Kahkoska, A.R.; Lawrence, J.M.; Peterson, C.M.; Dolan, L.; Pihoker, C.; et al. Disordered Eating Behaviors in Youth and Young Adults With Type 1 or Type 2 Diabetes Receiving Insulin Therapy: The SEARCH for Diabetes in Youth Study. Diabetes Care 2019, 42, 859–866. [Google Scholar] [CrossRef]
- Elhabashy, S.A.; Abd ElMalak, M.W.; Elrassas, H.H.; Thabet, R.A. Disordered eating and behaviors among young Egyptians with type 1 diabetes: Risk factors and comorbidities. J. Pediatr. Endocrinol. Metab. 2022, 35, 1385–1393. [Google Scholar] [CrossRef] [PubMed]
- Toni, G.; Berioli, M.G.; Cerquiglini, L.; Ceccarini, G.; Grohmann, U.; Principi, N.; Esposito, S. Eating Disorders and Disordered Eating Symptoms in Adolescents with Type 1 Diabetes. Nutrients 2017, 9, 906. [Google Scholar] [CrossRef]
- Neumark-Sztainer, D.; Patterson, J.; Mellin, A.; Ackard, D.M.; Utter, J.; Story, M.; Sockalosky, J. Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: Associations with sociodemographics, weight concerns, familial factors, and metabolic outcomes. Diabetes Care 2002, 25, 1289–1296. [Google Scholar] [CrossRef] [PubMed]
- Wagner, G.; Karwautz, A. Eating disorders in adolescents with type 1 diabetes mellitus. Curr. Opin. Psychiatry 2020, 33, 602–610. [Google Scholar] [CrossRef]
- Troncone, A.; Cascella, C.; Chianese, A.; Zanfardino, A.; Piscopo, A.; Borriello, A.; Casaburo, F.; Del Giudice, E.M.; Iafusco, D. Body Image Problems and Disordered Eating Behaviors in Italian Adolescents With and Without Type 1 Diabetes: An Examination With a Gender-Specific Body Image Measure. Front. Psychol. 2020, 11, 556520. [Google Scholar] [CrossRef] [PubMed]
- Rancourt, D.; Foster, N.; Bollepalli, S.; Fitterman-Harris, H.F.; Powers, M.A.; Clements, M.; Smith, L.B. Test of the modified dual pathway model of eating disorders in individuals with type 1 diabetes. Int. J. Eat. Disord. 2019, 52, 630–642. [Google Scholar] [CrossRef]
- Sassmann, H.; Albrecht, C.; Busse-Widmann, P.; Hevelke, L.K.; Kranz, J.; Markowitz, J.T.; Marshall, L.F.; Meurs, S.; de Soye, I.H.; Lange, K. Psychometric properties of the German version of the Diabetes Eating Problem Survey-Revised: Additional benefit of disease-specific screening in adolescents with Type 1 diabetes. Diabet. Med. 2015, 32, 1641–1647. [Google Scholar] [CrossRef]
- Hall, R.; Keeble, L.; Sunram-Lea, S.I.; To, M. A review of risk factors associated with insulin omission for weight loss in type 1 diabetes. Clin. Child Psychol. Psychiatry 2021, 26, 606–616. [Google Scholar] [CrossRef]
- Polonsky, W.H.; Anderson, B.J.; Lohrer, P.A.; Aponte, J.E.; Jacobson, A.M.; Cole, C.F. Insulin omission in women with IDDM. Diabetes Care 1994, 17, 1178–1185. [Google Scholar] [CrossRef]
- De Paoli, T.; Rogers, P.J. Disordered eating and insulin restriction in type 1 diabetes: A systematic review and testable model. Eat. Disord. 2018, 26, 343–360. [Google Scholar] [CrossRef]
- Araia, E.; Hendrieckx, C.; Skinner, T.; Pouwer, F.; Speight, J.; King, R.M. Gender differences in disordered eating behaviors and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth-Australia. Int. J. Eat. Disord. 2017, 50, 1183–1193. [Google Scholar] [CrossRef]
- Troncone, A.; Chianese, A.; Zanfardino, A.; Cascella, C.; Confetto, S.; Piscopo, A.; Loffredo, G.; Golino, A.; Iafusco, D. Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents’ Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems. J. Clin. Psychol. Med. Settings 2020, 27, 727–745. [Google Scholar] [CrossRef] [PubMed]
- Baechle, C.; Castillo, K.; Straßburger, K.; Stahl-Pehe, A.; Meissner, T.; Holl, R.W.; Giani, G.; Rosenbauer, J. Is disordered eating behavior more prevalent in adolescents with early-onset type 1 diabetes than in their representative peers? Int. J. Eat. Disord. 2014, 47, 342–352. [Google Scholar] [CrossRef] [PubMed]
- Goebel-Fabbri, A.E.; Fikkan, J.; Franko, D.L.; Pearson, K.; Anderson, B.J.; Weinger, K. Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 2008, 31, 415–419. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Sex | Age Groups | |||||
---|---|---|---|---|---|---|
Variables | Female n = 163 | Male n = 102 | p Effect Size | Adolescent n = 143 | Young Adult n = 122 | p Effect Size |
Male sex, n (%) | - | - | - | 60 (42) | 42 (34.4) | 0.209 |
Age, years, mean (SD) | 17.96 (3.7) | 17.2 (3.2) | 0.080 | 15 (1.8) | 20.8 (2.2) | <0.001 * |
HbA1c, mean (SD) | 8.5 (1.97) | 8 (2.3) | 0.081 | 8.5 (2.2) | 8.1 (2) | 0.134 |
Duration in years, mean (SD) | 7.4 (4.8) | 6.4 (4.7) | 0.079 | 5.2 (3.9) | 9.2 (4.9) | <0.001 * |
Age at onset, years, mean (SD) | 10.5 (4.5) | 10.8 (4) | 0.574 | 9.8 (3.7) | 11.6 (4.8) | <0.001 * |
Insulin dose, unit/Kg/day, mean (SD) | 1.1 (0.4) | 1.1 (0.4) | 0.616 | 1.1 (0.4) | 1.1 (0.4) | 0.730 |
BMI, kg/m2, mean (SD) | 22 (4.6) | 20.2 (3.7) | <0.001 * d = 0.42 | 20.7 (4.2) | 22 (4.4) | 0.017 * d = 0.297 |
BMI class, n (%) | ||||||
Underweight/Normal weight | 129 (79.1) | 92 (90.2) | 0.019 * | 119 (83.2) | 102 (83.6) | 0.932 |
Overweigh/Obese | 34 (20.9) | 10 (9.8) | 24 (16.8) | 20 (16.4) | ||
Education level, n (%) | ||||||
Low education | 52 (31.9) | 41 (40.2) | 0.169 | 80 (55.9) | 13 (10.7) | <0.001 * |
High education | 111 (68.1) | 61 (59.8) | 63 (44.1) | 109 (89.3) | ||
Family education level, n (%) | ||||||
Low education | 57 (35) | 41 (40.2) | 0.391 | 46 (32.2) | 52 (42.6) | 0.079 |
High education | 106 (65) | 61 (59.8) | 97 (67.8) | 70 (57.4) | ||
Family history of diabetes, n (%) | 97 (59.5) | 51 (50) | 0.129 | 67 (46.9) | 81 (66.4) | <0.001 * |
CGM use, n (%) | 116 (71.2) | 77 (75.5) | 0.441 | 121 (84.6) | 72 (59.0) | <0.001 * |
SMBG using fingerstick, n (%) | 123 (75.5) | 61 (59.8) | 0.007 * | 91 (63.6) | 93 (76.2) | 0.027 * |
Carb counting, n (%) | 48 (29.4) | 23 (22.5) | 0.217 | 33 (23.1) | 38 (31.1) | 0.139 |
DKA history in 6 months, n (%) | 21 (12.9) | 6 (5.9) | 0.01 * | 17 (11.9) | 10 (8.2) | 0.322 |
Recent severe hypoglycemia, n (%) | 31 (19) | 7 (6.9) | 0.006 * | 22 (15.4) | 16 (13.1) | 0.599 |
Admission due to hypoglycemia in the last 6 months, n (%) | 9 (5.5) | 5 (4.9) | 0.82 | 8 (5.6) | 6 (4.9) | 0.806 |
DEPS-R score, mean (SD) | 16.8 (10.9) | 13.3 (10) | 0.010 * d= 0.33 | 15.3 (11.5) | 15.6 (9.7) | 0.774 |
DEPS-R ≥ 20 | 53 (32.5) | 19 (18.6) | 0.013 * | 41 (28.7) | 31 (25.4) | 0.552 |
Insulin restriction, n (%) | 48 (29.4) | 25 (24.5) | 0.381 | 43 (30.1) | 30 (24.6) | 0.320 |
Insulin omission, n (%) | 23 (14.1) | 9 (8.8) | 0.199 | 17 (11.9) | 15 (12.3) | 0.919 |
Variables | Total (n = 265) | DEB (n = 72) | No DEB (n = 193) | p, Effect Size |
---|---|---|---|---|
Male sex, n (%) | 102 (38.5) | 19 (26.4) | 83 (43) | 0.013 * |
Age in years, mean (SD) | 17.7 (3.5) | 17.8 (3.3) | 17.63 (3.6) | 0.787 |
HbA1c, mean (SD), % | 8.3 (2.1) | 9.6 (2.2) | 7.9 (1.9) | <0.001 *, d = 0.87 |
Duration, mean (SD), years | 7 (4.8) | 6.7 (5) | 7.1 (4.7) | 0.567 |
Age at onset in years, mean (SD) | 10.6 (4.3) | 11 (4.4) | 10.5 (4.2) | 0.402 |
Insulin dose, unit/Kg/day, mean (SD) | 1.1 (0.4) | 1 (0.4) | 1.1 (0.41) | 0.120 |
BMI, kg/m2, mean (SD) | 21.3 (4.3) | 23.4 (5.1) | 20. (3.7) | <0.001 *, d = 0.69 |
BMI class, n (%) | ||||
Underweight/Normal weight | 221 (83.4) | 46 (63.9) | 175 (90.7) | <0.001 * |
Overweigh/Obese | 44 (16.6) | 26 (36.1) | 18 (9.3) | |
Poor glycemic control, n (%) | 166 (62.6) | 63 (87.5) | 103 (53.4) | <0.001 * |
Education level, n (%) | ||||
Low education | 93 (35.1) | 27 (37.5) | 66 (34.2) | 0.616 |
High education | 172 (64.9) | 45 (62.5) | 127 (65.8) | |
Family education level, n (%) | ||||
Low education | 98 (37) | 29 (40.3) | 69 (35.8) | 0.497 |
High education | 167 (63) | 43 (59.7) | 124 (64.2) | |
Family history of diabetes, n (%) | 148 (55.8) | 37 (51.4) | 111 (57.5) | 0.372 |
CGM use, n (%) | 193 (72.8) | 51 (70.8) | 142 (73.6) | 0.655 |
SMBG by fingerstick, n (%) | 184 (69.4) | 48 (66.7) | 136 (70.5) | 0.550 |
Carb counting, n (%) | 71 (26.8) | 14 (19.4) | 57 (29.5) | 0.099 |
DKA history in 6 months, n (%) | 27 (10.2) | 12 (16.7) | 15 (7.8) | 0.033 * |
Recent severe hypoglycemia, n (%) | 38 (14.3) | 20 (27.8) | 18 (9.3) | <0.001 * |
Admission due to hypoglycemia in the last 6 months, n (%) | 14 (5.3) | 7 (9.7) | 7 (3.6) | 0.048 * |
Insulin restriction, n (%) | 73 (27.5) | 43 (59.7) | 30 (15.5) | <0.001 * |
Insulin omission, n (%) | 32 (12.1) | 27 (37.5) | 5 (2.6) | <0.001 * |
Variables | Restrictors (n= 73) | Non-Restrictors (n= 192) | p, Effect Size |
---|---|---|---|
Age in years, mean (SD) | 17.7 (3.4) | 17.7 (3.4) | 0.929 |
BMI, kg/m2, mean (SD) | 22.1 (4.6) | 21 (4.2) | 0.077 |
HbA1c, mean (SD) | 9.2 (2.2) | 8 (2) | <0.001 *, d = 0.60 |
Duration in years, mean (SD) | 6.1 (4.6) | 7.4 (4.8) | 0.064 |
Age at onset in years, mean (SD) | 11.6 (4.5) | 10.3 (4.2) | 0.041 *, d = 0.29 |
DEPS-R score, mean (SD) | 24.8 (10.4) | 11.8 (8.4) | <0.001 *, d = 1.4 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Yafei, S.; Hummadi, A.; Badedi, M.; Darraj, H.; Khawaji, A.; Alzughbi, T.; Abutaleb, R.; Alhagawy, A.J.; Alnami, A.; Kudam, B.; et al. Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes. Medicina 2023, 59, 345. https://doi.org/10.3390/medicina59020345
Yafei S, Hummadi A, Badedi M, Darraj H, Khawaji A, Alzughbi T, Abutaleb R, Alhagawy AJ, Alnami A, Kudam B, et al. Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes. Medicina. 2023; 59(2):345. https://doi.org/10.3390/medicina59020345
Chicago/Turabian StyleYafei, Saeed, Abdulrahman Hummadi, Mohammed Badedi, Hussain Darraj, Abdullah Khawaji, Turki Alzughbi, Raed Abutaleb, Ali Jaber Alhagawy, Awaji Alnami, Bayan Kudam, and et al. 2023. "Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes" Medicina 59, no. 2: 345. https://doi.org/10.3390/medicina59020345