Psychopathological aspects of EDs in adolescents with type 1 diabetes: Findings from the DEPS-R and clinical outcomes.
Adolescence is marked by significant physiological and psychological changes that can lead to body image dissatisfaction and eating disorders (ED). Adolescents with type 1 diabetes mellitus (T1DM) may engage in restrictive dieting or insulin manipulation to control weight, risking severe complications. This study aims to identify adolescents with T1DM at risk for diabetes-specific eating behaviors using the Diabetes-Specific Eating Problems Scale-Revised (DEPS-R) and assess associated psychopathological factors, including diabulimia.
Adolescents (10-18 years) with T1DM who were under follow-up in our clinic within the past year were included. Patients were categorized into 3 metabolic control groups according to HbA1c levels: good (<7%), moderate (7-9%), and poor (>9%) based on the cumulative glycemic index that was calculated from the average HbA1c values over the past year. Eating behaviors were assessed using the DEPS-R scale, with scores≥20 indicating risk for ED. Individuals with high DEPS-R scores (at-risk group) were referred for psychiatric evaluation.
A total of 11.2% our of 80 adolescents, were identified as at risk for EDs. The mean DEPS-R score of the at-risk group was significantly higher vs the other group (25.8±3.5 vs 10.0±4.6, p<0.001). No significant differences were observed for age, gender, height SDS, and relative BMI. Although the at-risk group had a higher cumulative glycemic index and longer diabetes duration, there was no statistical significance (p=0.29, 0.28, respectively). Logistic regression analysis, adjusted for age, sex, diabetes duration, and comorbidities, did not identify statistically significant predictors of high DEPS-R scores. A weak positive correlation was found between high DEPS-R scores and basal-bolus insulin therapy (r=0.09, p=0.03). Psychopathology was observed in 55% of high-risk adolescents, with a higher prevalence in the poor metabolic control subgroup.
Although the DEPS-R scale is a valuable tool for identifying not only EDs but also early changes in eating behaviors in adolescents with T1DM, psychiatric evaluation is essential for confirming underlying psychopathology. Psychological factors play a key role in shaping eating behaviors, highlighting the need for integrated care combining diabetes management with psychological support.
Adolescents (10-18 years) with T1DM who were under follow-up in our clinic within the past year were included. Patients were categorized into 3 metabolic control groups according to HbA1c levels: good (<7%), moderate (7-9%), and poor (>9%) based on the cumulative glycemic index that was calculated from the average HbA1c values over the past year. Eating behaviors were assessed using the DEPS-R scale, with scores≥20 indicating risk for ED. Individuals with high DEPS-R scores (at-risk group) were referred for psychiatric evaluation.
A total of 11.2% our of 80 adolescents, were identified as at risk for EDs. The mean DEPS-R score of the at-risk group was significantly higher vs the other group (25.8±3.5 vs 10.0±4.6, p<0.001). No significant differences were observed for age, gender, height SDS, and relative BMI. Although the at-risk group had a higher cumulative glycemic index and longer diabetes duration, there was no statistical significance (p=0.29, 0.28, respectively). Logistic regression analysis, adjusted for age, sex, diabetes duration, and comorbidities, did not identify statistically significant predictors of high DEPS-R scores. A weak positive correlation was found between high DEPS-R scores and basal-bolus insulin therapy (r=0.09, p=0.03). Psychopathology was observed in 55% of high-risk adolescents, with a higher prevalence in the poor metabolic control subgroup.
Although the DEPS-R scale is a valuable tool for identifying not only EDs but also early changes in eating behaviors in adolescents with T1DM, psychiatric evaluation is essential for confirming underlying psychopathology. Psychological factors play a key role in shaping eating behaviors, highlighting the need for integrated care combining diabetes management with psychological support.
Authors
Bilici Bilici, Altıntaş Altıntaş, Özsu Özsu, Şıklar Şıklar, Berberoğlu Berberoğlu, Aycan Aycan
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