Diabetes Eating Problem Survey-Revised Research Articles

Psychometric properties of the Diabetes Eating Problem Survey-Revised among Dutch adults with type 1 diabetes and implications for clinical use.

Disordered eating behaviour (DEB) in people with type 1 diabetes (T1D) can be screened with the Diabetes Eating Problem Survey-Revised (DEPS-R). This study aimed to investigate the psychometric properties of the DEPS-R among Dutch adults with T1D and to explore the individual items alongside the standard cut-off score of ≥20 for clinical use. The construct validity of the DEPS-R was assessed with an exploratory factor analysis, through principal axis factoring and with Spearman correlations between clinical variables and the DEPS-R. Backward logistic regression identified clinical predictors for DEPS-R scores above the cut-off. DEPS-R item responses were summarized with frequencies, means and standard deviations. Participants were 145 adults with T1D, of whom 79.3% were women and 35.9% presented with DEB based on the cut-off. A single-factor solution of the DEPS-R showed good internal consistency, while a three-factor solution showed acceptable to good internal consistency within the factors. A younger age, a higher BMI and more diabetes distress were predictors for a DEPS-R cut-off score of ≥20. Clinically relevant items were identified that contributed minimally to the DEPS-R score. This study supports a single-factor and a three-factor structure of the DEPS-R while also suggesting an item-specific or factor-specific approach in clinical practice.

Disordered eating behaviours and body shape dissatisfaction among adolescents with type 1 diabetes: a cross sectional study

BackgroundDisordered eating behaviours (DEBs) are variations in regular eating patterns and behaviours and might include symptoms and behaviours of eating disorder with lower level of severity. Such behaviours are common during adolescence at which time several physical and psychological changes occur favouring unhealthy dietary behaviours. Although the magnitude of DEBs is high among high—income countries, similar data are limited among adolescents with diabetes in low-income countries including Ethiopia. This study aimed to assess the magnitude of DEBs and its relationship with body shape dissatisfaction among adolescents with diabetes on follow-up at selected public hospitals in Addis Ababa, Ethiopia.MethodsHospital based cross sectional study was conducted among randomly selected 395 adolescents with diabetes attending public hospitals in Addis Ababa from January to December, 2021. Data were collected using structured pretested standard diabetes eating problem survey revised (DEPS-R) questionnaire, body part satisfaction scale of 8 items, and anthropometric measurements. Descriptive statistics such as median alongside interquartile range was used to describe the continuous variables. Binary bivariable and multivariable logistic regression was used for data analysis. Mann–Whitney U-test and Kruskal–Wallis test were used to evaluate the difference between median scores of independent variables. Adjusted odds ratios (AOR) alongside 95% confidence intervals (CIs) were estimated to measure the strength of association between variables of interest.ResultsThe magnitude of disordered eating behaviours within the last 30 days was 43.3%, [95% CI: (38%, 48%)]. In multivariable analysis, body shape dissatisfaction [AOR = 2.21, 95% CI (1.28, 3.82, p = 0.0001)], family history of diabetes mellitus [AOR = 1.59, 95% CI (1.03, 2.47, p = 0.038)], late adolescence period [AOR = 2.10, 95% CI (1.33, 3.34, p = 0.002)], having diabetic complication[AOR = 2.32, 95% CI (1.43, 3.75, p = 0.001)],and being overweight [AOR = 2.25, 95% CI (1.32, 3.82, p = 0.003)] were significantly associated with DEBs.ConclusionsThe magnitude of DEBs was high among the study participants. Body shape dissatisfaction, family history of diabetes mellitus, being in late adolescence period, diabetic complication, and nutritional status of adolescents were significantly associated with DEBs. Therefore, preventive interventions need to be designed by all relevant actors working on health promotion of young population to address factors influencing DEBs among adolescent population with diabetes.

Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study.

Type 1 diabetes (T1D) causes psychological distress, negatively impacting normal childhood activities. Depression, anxiety disorders, and eating problems are commonly observed in this population. The study population consisted of 40 adolescents (22 females and 18 males) who had been diagnosed with T1D and 41 healthy adolescents (21 females and 20 males). The aim of this study was to compare adolescents with T1D to healthy controls in terms of depression, anxiety, and eating problems and subsequently examine the T1D group in relation to the risk of diabetes-specific eating disorders. Eating Attitudes Test (EAT-40), Revised Children's Anxiety and Depression Scale (RCADS), and Diabetes Eating Problem Survey- Revised (DEPS-R) scales were used to compare the case and control groups. The case group exhibited significantly higher scores in EAT-40 total score, RCADS parent form major depressive disorder (MDD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD), total anxiety score, total scale scores, RCADS child form MDD, PD, and total scale scores compared to the control group. Individuals at high risk of diabetes-specific eating disorder within the case group demonstrated significantly higher RCADS (child and parent form) MDD scores and RCADS parent form separation anxiety (SA) and total scale scores. Binary logistic regression analysis revealed that the RCADS parent form total scale score could predict DEPS-R. Routine screening of children and adolescents diagnosed with T1D for depression, anxiety, and eating disorder risk may facilitate early detection of possible psychopathologies, allowing for early intervention to address factors that may disrupt treatment adherence. Further longitudinal studies with larger samples are needed to investigate psychopathologies, particularly eating disorders, in children and adolescents with T1D.

Psychometric properties and factor structure of the diabetes eatıng problem survey- revised (DEPS-R) among adults with type 1 diabetes mellitus

Background and objectiveAlthough many studies on the Diabetes Eating Problem Survey–Revised (DEPS-R) in adolescents with type 1 diabetes mellitus (T1D), the number of studies validating this questionnaire in adults with T1D is limited. Therefore, this study aimed to examine the factor structure of the Turkish version of the DEPS-R in adults with T1D and internal consistency and construct validity.MethodsA total of 100 patients with T1D, ages 18–50 years, completed the DEPS-R and EDE-Q. In addition to tests of validity, confirmatory factor analysis was conducted to investigate the factor structure of the 6-item Turkish version of DEPS-R.ResultsThe Cronbach’s alpha coefficient of the DEPS-R Turkish version was 0.77, suggesting good internal consistency. The median (IQ) DEPS-R score was 15.0 (13.0) among all participants. DEPS-R score was significantly correlated with BMI (r = 0.210; p < 0.05) and EDE-Q (r = 0.586; p < 0.01). There was no correlation between the HbA1c values of participants and neither EDE-Q nor DEPS-R scores. The confirmatory factor analysis results show that the three-factor model was a good fit.ConclusionA short, self-administered diabetes-specific screening tool for disordered eating behavior is recommended be used routinely in the clinical care of adults with T1D, and Turkish version of DEPS-R has acceptable internal consistency and construct validity in adults with T1D.Level of evidenceLevel V, descriptive study.Clinicaltrials.gov registration number NCT05346679/ 21.04.2022 (retrospectively registered)

1135-P: Screening for Disordered Eating Behaviors in Youth with Type 1 Diabetes—Feasible and Necessary

The American Diabetes Association (ADA) recommends screening adolescents with type 1 diabetes (T1D) for disordered eating behaviors (DEB) using the Diabetes Eating Problem Survey-Revised (DEPS-R) tool, however this is not routinely done in clinical practice. We implemented screening for DEB in a large academic pediatric diabetes center as part of clinical care as well as to evaluate the prevalence of DEB and identify clinical factors (in particular, use of pumps and continuous glucose monitors (CGM)) associated with a positive screen. Youth with T1D between 13-19 years, seen in our pediatric diabetes clinic from 02/09/2022 - 06/07/2022, were given the survey. A total of 580 subjects were eligible for the screening, 368 (64%) completed it and 282 (~50%) had analyzable data (49% female, 83% white, 11% black, 3% reporting food insecurity (FI), mean (SD) age 16.4±1.9 years, HbA1c 8.2±1.9%, BMI percentile 71.2±26.9). The majority were on CGM (77%) and 45% on pump therapy (including 5% on hybrid close loop systems). A total of 43 (15%) had a positive screen (score≥ 20) for DEB. There was a higher proportion of females, (67 vs 45%, p=0.007) lower proportion of white (70 vs 85%) and higher proportion of black youth (20 vs 8%) (p=0.02) in those that screened positive vs negative. Those with a positive screen also had a higher HbA1c (9.9±2.1 vs 8±1.7, p&amp;lt;0.001) and BMI percentile (83.1±21.1 vs 68.9±27.3, p&amp;lt;0.001). There was no difference in age (16.5±1.9 vs 16.4±1.9 years, p=0.82), report of FI (4.6 vs 2.1%, p=0.76), use of CGM (72 vs 78%, p=0.35), or pump therapy (35 vs 44%, p-0.26) between the two groups. None of those on hybrid close loop had a positive screen, however the numbers were small (n=7). Almost 1 in 5 adolescents with T1D had a positive screen for DEB. There was no difference in the use of diabetes technology. Our findings stress the importance of screening for DEB in youth with T1D and implementation of strategies to improve response rate in order to make timely referrals to reduce associated morbidity. Disclosure S.Sastry: None. M.Coren: None. J.Schreiber: None. I.Libman: Advisory Panel; Novo Nordisk.

Validation of the traditional Chinese version of the diabetes eating problem survey-revised and study of the prevalence of disordered eating patterns in Chinese patients with type 1 DM

BackgroundDisordered eating behaviours (DEBs) in patients with type 1 diabetes mellitus (T1DM) are associated with an increased risk of complications and mortality. The Diabetes Eating Problem Survey-Revised (DEPS-R) was developed to screen for DEBs in T1DM patients. The objectives of this study were to develop a traditional Chinese version DEPS-R (electronic version) and to measure the prevalence of DEBs in a local population sample.MethodsThe DEPS-R was translated into traditional Chinese, modified and developed into an electronic version. The psychometric properties of the C-DEPS-R were tested on T1DM patients from 15 to 64 years old. The factor structure of the traditional C-DEPS-R was examined by confirmatory factor analysis (CFA). The C-EDE-Q and the C-DES-20 were used for convergent and divergent validity testing, respectively. Module H of the CB-SCID-I/P was used as a diagnostic tool for eating disorders. A correlation study was conducted with the C-DEPS-R scores obtained and the clinical characteristics. Type 2 diabetic (T2DM) patients on insulin treatment were recruited as controls.ResultsIn total, 228 T1DM patients and 58 T2DM patients were recruited. There was good internal consistency of the traditional C-DEPS-R (electronic version), with the McDonald’s omega of 0.825 and test-retest reliability of 0.991. A three-factor model of the traditional C-DEPS-R was confirmed by CFA. The cut-off score for the traditional C-DEPS-R was determined to be 24; 13.2% (95% CI 8.8%-17.5%) of T1DM patients were found to score above the cut-off score, while 7.5% (95% CI 4-10.9%) scored above the cut-off by the C-EDE-Q, and 4.4% (95% CI 2.1%-7.9%) were diagnosed with eating disorders by the CB-SCID-I/P Module H. Females with T1DM scored higher on the traditional C-DEPS-R. There was a significant correlation of the C-DEPS-R with BMI, occurrence of DKA, use of a continuous glucose monitoring system and positive diagnosis by the CB-SCID-I/P module H (p < 0.05).ConclusionThe traditional Chinese-DEPS-R (electronic version) demonstrated good psychometric properties. It is a self-rated, time-efficient and reliable tool for the screening of disordered eating behaviours in T1DM patients in the Chinese population of Hong Kong.Plain English SummaryDisordered eating behaviours, such as insulin omission, are associated with an increased risk of diabetes mellitus-related complications and mortality. Generic screening tools for eating disorders may over- or underestimate such problems in diabetic patients. Type 1 diabetes mellitus patients are at particular risk of developing disordered eating behaviours or eating disorders, yet studies in Chinese populations are limited. This study developed and validated the traditional Chinese (electronic) version of the Diabetes Eating Problem Survey-Revised (DEPS-R). The traditional Chinese-DEPS-R is a self-rated, time-efficient and reliable tool for the screening of disordered eating behaviours in Type 1 diabetes mellitus patients in the Chinese population of Hong Kong. The study also estimated the prevalence of disordered eating behaviours in diabetic patients from the local Chinese population, and the clinical correlations of the symptoms and clinical parameters were explored. The study reflected a higher prevalence of eating problems in the Type 1 diabetes mellitus population and demonstrated significant correlations of eating problems with BMI as well as the occurrence of diabetic ketoacidosis. Correspondence: lcw891@ha.org.hk.

Diabetes-specific eating disorder and possible associated psychopathologies in adolescents with type 1 diabetes mellitus

PurposeIt was aimed to investigate the frequency of the risk of diabetes-specific eating disorder (DSED) in adolescents with type 1 diabetes mellitus (T1DM) and to reveal the accompanying psychopathologies.MethodsAdolescents with T1DM aged 12–18 who applied to the pediatric diabetes outpatient clinic between July 2021 and March 2022 were included. Diabetes Eating Problem Survey-Revised (DEPS-R) was applied to all patients to determine the risk of DSED. In order to detect accompanying psychopathologies, Eating Disorder Examination Questionnaire (EDE-Q), Child Anxiety and Depression Scale-Child version (RCADS) and Parenting Style Scale were applied. After completing the scales, semi-structured interviews were conducted with all patients by a child and adolescent psychiatrist.ResultsNinety-two adolescents (45 boys, 47 girls) were included. DSED risk was found in 23.9% of the cases. A positive correlation was found between DEPS-R and EDE-Q scores (p = 0.001, rho = 0.370). RCADS mean scores were significantly higher in the group with DSED risk (p < 0.001). When the Parenting Style Scale was evaluated, psychological autonomy scores were significantly lower in the group with DSED risk (p = 0.029). As a result of the psychiatric interviews, 30 (32.6%) patients had at least 1 psychiatric disorder. Of these, 2 patients were diagnosed with eating disorder.ConclusionAlmost one-fourth of adolescents with T1DM were found to be at risk of DSED. Routine screening of adolescents with T1DM with the DEPS-R scale may provide early detection of DSED, and referral of those at risk to child psychiatry enables early diagnosis and intervention for both eating disorders and accompanying psychopathologies.Level of evidenceLevel III: Evidence obtained from cohort or case-control analytic studies.

Prevalence and Multidimensional Model of Disordered Eating in Youths With Type 1 Diabetes: Results From a Nationwide Population-Based Study.

The aim of this study was to report nationwide data of the prevalence of disordered eating behaviors (DEBs) in adolescents with type 1 diabetes (T1D) and to evaluate a multidimensional model of eating problems, analyzing how psychopathological problems are associated with DEBs and with metabolic control. This study was carried out using a cross-sectional design with a sample of 1,562 patients with T1D (812 male), aged 11-19 years. Participants were recruited from multiple pediatric diabetes centers (N = 30) located in northern, central, and southern Italy, and they individually completed the Diabetes Eating Problem Survey-Revised (DEPS-r) and the Youth Self-Report (YSR). Sociodemographic and clinical data were also gathered. Multiple-group structural equation modeling was used to investigate the relationships between internalizing/externalizing symptoms, DEBs, and glycosylated hemoglobin (HbA1c) values. A total of 29.7% of the participants reported DEBs (DEPS-r scores ≥20), 42.4% reported insulin manipulation (IM). The prevalence of DEBs was higher for female participants (p ≤ .001). The model explains 37% of the variance in disordered eating, 12% in IM, and 21% in HbA1c values. Body mass index, externalizing symptoms, and internalizing symptoms were significantly and positively associated with DEBs, which in turn were significantly and positively associated with HbA1c values (all p ≤ .001). Externalizing (p ≤ .001) and internalizing (p ≤ .01) symptoms were also directly associated with HbA1c values. Given the relevant prevalence of DEBs, their significant positive association with psychopathological symptoms, and their relationship with worse diabetes outcomes, regular psychological screening and support is needed to ensure the best care of adolescents with T1D.

Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes

Background and Objectives: The prevalence of disordered eating behaviors (DEBs) in type 1 diabetes (T1D) has been studied globally; however, data from Saudi Arabia and Arab-speaking countries are scarce. This study aimed to measure the prevalence of DEBs and associated clinical characteristics in adolescents and young adults with T1D, and the impact of DEBs on glycemic parameters. Materials and Methods: A total of 265 adolescents and young adults with T1D (aged 12-25 years) were recruited randomly from the registry at the Jazan Endocrinology and Diabetes Center, Saudi Arabia. Participants completed the Diabetes Eating Problem Survey-Revised (DEPS-R) questionnaire. Other measures included hemoglobin A1c (HbA1c) in addition to sociodemographic, anthropometric, and clinical data. Results: The prevalence of DEBs among T1D was 27.2%. Females (32.5%) had a higher proportion of DEBs than males (18.6%) (p = 0.01). About 27% of the participants reported insulin restriction. A history of hospital admission in the previous 6 months due to DKA and frequent hypoglycemia was more frequently reported in T1D participants with DEBs compared to those without (p = 0.03). Participants with DEBs had higher HbA1c and higher BMI compared to those without DEBs. Conclusions: Adolescents and young adults with T1D with disordered eating and insulin restriction have higher glycated hemoglobin, and are at higher risk of DKA. Routine screening for DEBs should be an essential element in diabetes care, especially among highly vulnerable groups.

Patients’ perspectives on screening for disordered eating among adolescents with type 1 diabetes

PurposePeople with type 1 diabetes have an increased risk of disordered eating (DE) and eating disorders (ED). Screening is recommended however little is known about patients’ perspectives on screening questionnaires. This paper reports qualitative analyses of patients’ perspectives on the questionnaire Diabetes Eating Problem Survey Revised (DEPS-R), including acceptability, attitudes, and cognitive understanding.Research design and methods15 adolescents with type 1 diabetes between 11 and 18 years, were interviewed. A semi-structured format and a qualitative Interpretive Descriptive (ID) methodology was chosen.ResultsThe analyses identified four themes: (1) The Questionnaire, (2) Reframing Diabetes Visits, (3) This is (not) for me, and (4) Out in the Open. The DEPS-R was completed with-in 5–10 min. with no technical difficulties. The questionnaire altered the diabetes visit for some, creating a new dialog, and time for self-reflection. Adolescents appreciated the direct approach in the questionnaire, and showed willingness to complete the questionnaire, when presented to them by a health care professional (HCP). One item in the DEPS-R proved difficult to understand for some participants.ConclusionThe study highlights DEPS-R as a clinically relevant screening questionnaire. Completing DEPS-R prior to a consultation opens the door to a consultation that invites the adolescent to address matters of eating behavior. Our findings suggest that systematic screening of DE/ED using the DEPS-R is both accepted and welcomed by adolescents with type 1 diabetes. Future research should focus on a potential update of selected items in DEPS-R.Level of evidenceV – qualitative study.

Validation of the Arabic Version of Diabetes Eating Problem Survey-Revised (DEPS-R) among Adolescents with Type 1 Diabetes.

Disordered eating behaviors (DEBs) in type 1 diabetes (T1D) have been studied globally in different age groups. However, there is no validated diabetes-specific questionnaire in the Arabic language for the screening of DEBs. This study aimed to translate the Diabetes Eating Problem Survey-Revised scale (DEPS-R) into the Arabic language and study its psychometric properties in adolescents with T1D. We adopted the forward-backward procedure to translate the DEPS-R questionnaire into Arabic. The validation study enrolled 258 Saudi adolescents with T1D aged 12-18 years who completed the Arabic DEPS-R questionnaire and the EAT-26. The Arabic DEPS-R showed good construct validity and reliability (Cronbach's alpha = 0.86). The factor analysis revealed a three-factor structure of DEPS-R which explains 54.4 % of the variance. In total, 30.6% of the participants are at high risk for DEBs (DEPS-R score ≥ 20). The psychometric properties of the Arabic DEPS-R are satisfactory, consistent with the original scale and translations in other languages. These results support the validity of the Arabic DEPS-R for assessment of DEBs in the T1D Arabic population.

Eating disorders between male and female adolescents with type 1 diabetes mellitus in Korea.

Diabetes mellitus and its prevalence are rising dramatically in Korea and throughout the world, not only in adults but in adolescents. This study aimed to identify the sex-specific factors that influence eating disorders in adolescents with type 1 diabetes. A secondary analysis of a descriptive survey was employed. Raw data from 136 adolescents aged 13 to 18 years who were diagnosed with type 1 diabetes were obtained in the original study using the Diabetes Eating Problem Survey-Revised (DEPS-R), Rosenberg Self-Esteem Scale (RSES), and Beck Depression Inventory-II (BDI-II). The data were analyzed using the independent t-test and multiple regression analysis. The female and male participants with eating disorders scored 21.67 ± 11.70 and 13.15 ± 8.03 points, respectively. Among the adolescents with type 1 diabetes, the factors related to eating disorders in female participants were body image satisfaction (β = 0.48, p <0.001) and depression (β = 0.22, p = 0.043), accounting for 33.4% of the variance. While the factors related to eating disorders in the male participants were BMI (β = 0.33, p = 0.006) and depression (β = 0.28, p = 0.017), accounting for 17.4% of the variance. Sex-specific factors should be considered to induce healthy eating behavior in adolescents with type 1 diabetes and reduce eating disorders. Moreover, it is necessary for female adolescents to perceive their body type accurately, and male adolescents need exercise and nutrition education to lower their body mass index. Collaborations between medical practitioners, changes in the medical environment, and social interests are necessary. Since depression is the common factor associated with eating disorders in female and male adolescents with type 1 diabetes, a periodic depression screening test and intervention program that can lower depression should be developed. At the government level, it is necessary to strengthen economic support for cost interventions.

Emotional eating and disordered eating behaviors in children and adolescents with type 1 diabetes

Disordered eating behaviors (DEB) are more common in adolescents with type 1 diabetes (T1D) than in peers without diabetes. Emotional eating is a risk factor for binge eating in children and adolescents in the general population and is associated with increased intake of high energy-dense foods rich in sugars and fats. The primary objective is to evaluate whether emotional eating is associated with the metabolic control (glycated hemoglobin, plasma lipids and uric acid) in children and adolescents with type 1 diabetes and whether subjects with DEB (DEPS-R ≥ 20) have higher emotional eating than those without DEB. The secondary objective is to evaluate whether emotional eating is associated with the different symptoms of DEB. Emotional eating is positively correlated with HbA1c, total and LDL cholesterol values in children and adolescents with T1D. Subjects with DEB have a higher emotional eating score than subjects without DEB. Disinhibition is the most common disordered eating behavior in children and adolescents with T1D and is associated with a higher emotional eating score. Early identification and treatment of emotional eating could be tools for preventing DEB in people with type 1 diabetes. A total of 212 adolescents with T1D completed two self-administered questionnaires: the Diabetes Eating Problem Survey-Revised (DEPS-R) and the Emotional Eating Scale for Children and Adolescents (EES-C). Demographic (age, sex, duration of the disease), anthropometric (weight, height, BMI, BMI-SDS), therapeutic (type of insulin therapy, daily insulin dose) and metabolic (HbA1c, total cholesterol, HDL, LDL, triglycerides, uric acid) data were taken from the patients' medical records. The presence of other autoimmune diseases was also recorded.

Validity and Reliability of the Diabetes Eating Problem Survey-Revised (DEPS-R) in Mexican Population: An Instrumental Study

Objective: To evaluate the validity and reliability of the Diabetes Eating Problem Survey-Revised (deps-r) instrument to identify the risk of eating disorders (ed) in a Mexican population diagnosed with Diabetes Mellitus (dm). Methods: A three-stages instrument validation study. Stage 1. Translation: three translators, whose native language was Spanish, translated the English version of the deps-r instrument; Stage 2. Using the Delphi method, the validity of the content was estimated through an evaluation of five experts; subsequently the wording was evaluated applying the instrument to a pilot group of ten people; finally, the instrument was applied to a calculated sample (95% confidence interval; 5% error rate) of 130 patients. Stage 3: A psychometric evaluation was carried out, calculating Cronbach’s alpha, and Spearman’s correlation coefficients. Results: Cronbach’s alpha was 0.72. Spearman’s correlation coefficient was calculated, highlighting the weight/score ratio obtained in the second version of the deps-r with 0.3645 (p&lt;0.0001). Conclusion: there is good reliability in the translated and validated version of the instrument, making it an adequate screening measure for the identification of ed in the Mexican population.

Associations of disordered eating with the intestinal microbiota and short-chain fatty acids among young adults with type 1 diabetes

Background and aimsDisordered eating (DE) in type 1 diabetes (T1D) includes insulin restriction for weight loss with serious complications. Gut microbiota-derived short chain fatty acids (SCFA) may benefit host metabolism but are reduced in T1D. We evaluated the hypothesis that DE and insulin restriction were associated with reduced SCFA-producing gut microbes, SCFA, and intestinal microbial diversity in adults with T1D. Methods and resultsWe collected stool samples at four timepoints in a hypothesis-generating gut microbiome pilot study ancillary to a weight management pilot in young adults with T1D. 16S ribosomal RNA gene sequencing measured the normalized abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry measured SCFA (total, acetate, butyrate, and propionate). The Diabetes Eating Problem Survey—Revised (DEPS-R) assessed DE and insulin restriction. Covariate-adjusted and Bonferroni-corrected generalized estimating equations modeled the associations. COVID-19 interrupted data collection, so models were repeated restricted to pre-COVID-19 data.Data were available for 45 participants at 109 visits, which included 42 participants at 65 visits pre-COVID-19. Participants reported restricting insulin “At least sometimes” at 53.3% of visits. Pre-COVID-19, each 5-point DEPS-R increase was associated with a −0.34 (95% CI -0.56, −0.13, p = 0.07) lower normalized abundance of genus Anaerostipes; and the normalized abundance of Lachnospira genus was −0.94 (95% CI -1.5, −0.42), p = 0.02 lower when insulin restriction was reported “At least sometimes” compared to “Rarely or Never”. ConclusionDE and insulin restriction were associated with a reduced abundance of SCFA-producing gut microbes pre-COVID-19. Additional studies are needed to confirm these associations to inform microbiota-based therapies in T1D.

Higher score of diabetes eating problem survey-revised (DEPS-R) is associated with poor glycemic control among Brazilian patients with type 1 diabetes (T1DM): A brief report

Background and aimsThe diabetes eating problem survey-revised (DEPS-R) questionnaire is a specific and valuable tool for assessing disturbed eating behavior in type 1 diabetes mellitus. The literature suggests an association between a higher DEPS-R score and worse metabolic control; however, these figures have not been described in patients from Latin America. MethodsWe evaluated 58 patients with type 1 diabetes mellitus from a Brazilian outpatient clinic using the DEPS-R questionnaire. ResultsOverall, 23 participants with a high risk for high eating disorder behaviors exhibited significantly increased hemoglobin A1c levels compared with 35 patients with a DEPS-R score <20. ConclusionsOur data support that the presence of a DEPS-R score >20 negatively affects the metabolic control of patients with type 1 diabetes mellitus in Brazil.

The psychological profile of youth and young adults with type 1 diabetes in New Zealand.

The psychological status of New Zealanders living with type 1 diabetes (T1D) is unknown. This study's purpose is to determine the prevalence of general wellbeing, diabetes-specific distress, and disordered eating, and explore their relationships with glycemic control. Participants were patients aged 15-24 years with T1D (N=200) who attended their routine multidisciplinary clinic at the Waikato Regional Diabetes Service. They completed questionnaires including the World Health Organization Well-Being Index, the Problem Areas in Diabetes scales, and the Diabetes Eating Problem Survey-Revised. Clinical and demographic information were also collected. Median age of participants was 19.3 years and 14% identified as Māori (indigenous people of Aotearoa New Zealand). Median HbA1c was 73 mmol/mol. One fifth of participants experienced low emotional wellbeing, including 7.5% who experienced likely depression. Diabetes distress was found in 24.1%, and 30.7% experienced disordered eating behaviors. Differences were identified between Māori and non-Māori in measures of diabetes distress and disordered eating, with Māori more likely to score in clinically significant ranges (50% vs. 19.9%; 53.6% vs. 26.7%, p < 0.05). Disordered eating was correlated with HbA1c , body mass index, and social deprivation; diabetes distress was associated with HbA1c and inversely with age (all p < 0.05). This study is the first of its kind to determine that New Zealanders living with T1D experience significant psychological distress. Research with larger Māori representation is needed to more closely review identified inequities. Replication in other local clinics will help contribute to the ongoing development of normative data for Aotearoa New Zealand.

Association of executive function problems and disordered eating behaviours in teens with type 1 diabetes.

To explore cross-sectional associations between executive function problems and disordered eating behaviours in teens with type 1 diabetes. Executive function was assessed by the Behavior Rating Inventory of Executive Function (BRIEF), self-report and parent proxy-report versions. Scores ≥60 (on Global Executive Composite, Behavioral Regulation Index, Metacognition Index or clinical scales) indicated problems with executive function. Disordered eating behaviour was assessed by the Diabetes Eating Problem Survey Revised (DEPS-R) and categorized as follows: <10 low, 10-19 moderate and ≥20 high. In the 169 teens (46% girls, median age 16.0years [range 13.7-18.7], median diabetes duration 8.9years [range 1.4-16.6]), 29% had moderate and 12% had high level of disordered eating behaviours. Executive function problems were present in 9% by self report and 26% by parent proxy-report. Among teens with moderate/high level of disordered eating behaviours, 19% had executive function problems by self report (vs. 2% of teens with low level of disordered eating behaviours, p<0.001) and 33% had executive function problems by parent proxy-report (vs. 20% of teens with low level of disordered eating behaviours, p=0.056). A greater level of disordered eating behaviours was associated with executive function problems by teen self report on the General Executive Composite (p<0.001), Behavioral Regulation Index (p<0.001), emotional control clinical scale (p<0.001), shift clinical scale (p<0.001) and by parent proxy-report on the task initiation clinical scale (p=0.008). Assessing executive function and screening for disordered eating behaviours in teens with type 1 diabetes could help identify a subset of teens at high risk for adverse outcomes and need for intervention.

The Diabetes Eating Problem Survey-Revised (DEPS-R) in a Greek Adult Population with Type 1 Diabetes Mellitus: Model Comparison Supporting a Single Factor Structure.

Type 1 diabetes mellitus (T1DM) patients occasionally develop disordered eating behaviors, leading to insulin manipulation without medical consultation, targeting to achieve weight control. In clinical practice, the Diabetes Eating Problem Survey-Revised Version (DEPS-R) questionnaire has been used to evaluate eating disorders in T1DM patients. This study was conducted to validate the factor structure of the Greek version of DEPS-R using Confirmatory Factor Analysis (CFA), to investigate its reliability and convergent validity in Greek T1DM adults and to compare a single factor DEPS-R model with multiple factor models. Participants were 103 T1DM adults receiving insulin, who responded to DEPS-R. Their anthropometric, biochemical and clinical history data were evaluated. The sample presented good glycemic control and 30.1% scored above the established DEPS-R cut-off score for disturbed eating behavior. CFA results revealed that the data fit well to the factor models. The DEPS-R scale had good reliability and was positively linked to BMI, HbA1c, total daily dose and time in range. Model comparison supported the superiority of the 1-factor model, implying that Greek clinicians and practitioners might not have to consider individualized treatment based on various scores across different subscales but they can adopt a single DEPS-R score for an easy and efficient screening for disordered eating.

Prevalence of disordered eating in adults with type 1 diabetes in an Australian metropolitan hospital.

The purpose of this study is to establish the prevalence of disordered eating behaviours and establish its identifiable factors in adults with T1D attending a large tertiary hospital service. In this cross-sectional study, 199 participants with TID, aged 18-65years, completed the revised Diabetes Eating Problem Survey-Revised (DEPS-R). Additional demographic and medical data obtained included age, sex, BMI, HbA1C, duration of diabetes and number of hospital admissions within 12months (including diabetic ketoacidosis). A DEPS-R score of ≥20, indicative of disordered eating behaviour, was evident in 31% of participants. A DEPS-R score of ≥20 was associated with being female (39% females vs. 23.3% males; p=.016) and a high HbA1c (8.9% [7.8-10.2] vs. 8.0% [7.3-8.7], median [IQR], p<.001). The prevalence of disordered eating behaviours increased significantly with BMI, from 21.3% in the healthy BMI group (18.5-24.9kg/m2 ) to 37.1% in the group with BMI>25kg/m2 (p=.02). A DEPS-R score of ≥20 was often driven by questions related to a desire to lose weight, meal patterns and glycaemic control. While these behaviours may be attributed to desirable self-management behaviours for adults with T1D, the DEPS-R is still a useful tool to identify patients with potential disordered eating behaviours and the need for dietetic intervention.