Search Results (14)

Disordered eating has been identified as a concern among individuals with type 1 diabetes mellitus (T1DM) and is associated with poorer glycaemic control, which may result in vascular complications and increased morbidity and mortality. Despite this, there is a paucity of research examining disordered eating behaviour (DEB) among individuals with T1DM in Ireland. This study aimed to examine the prevalence of DEB among adults with T1DM attending an Irish hospital outpatient clinic. This cross-sectional study recruited 95 adults with T1DM attending an outpatient diabetes clinic at Sligo University Hospital. Screening for DEB was conducted using self-reported measures, including the Diabetes Eating Problem Survey–Revised (DEPS-R) and the Eating Disorder Examination Questionnaire (EDE-Q 6.0). DEB was identified in 16.3% (n = 15) of the participants using the DEPS-R and in 3.2% (n = 3) using the EDE-Q 6.0. Higher levels of DEB were observed among the female participants; however, a notable prevalence was also identified among the male participants. DEB demonstrated a weak positive correlation with body mass index (BMI) and a negative correlation with age and height. No association was found between DEB and glycated haemoglobin (HbA1c). The substantial prevalence of DEB among adults with T1DM, with nearly one in six participants affected, highlights the presence of clinically relevant disordered eating symptoms in this population. The findings suggest potential differences in case identification between diabetes-specific and generic screening tools. These results support further evaluation of diabetes-specific screening instruments such as the DEPS-R in adult T1DM populations within larger studies before routine clinical implementation. Full article

Background: Adolescents with type 1 diabetes (T1D) face considerable psychosocial demands that may increase vulnerability to diabetes-specific disordered eating behaviors. This study investigated the relationships among diabetes-specific disordered eating behaviors, social anxiety, social appearance anxiety, and psychological resilience in adolescents with T1D. Methods: This cross-sectional and correlational study included 176 adolescents diagnosed with T1D. Data were obtained using the Diabetes Eating Problem Survey-Revised (DEPS-R), the Social Anxiety Scale for Adolescents (SAS-A), the Social Appearance Anxiety Scale (SAAS), and the Child and Youth Resilience Measure (CYRM-12). Results: The mean age was 14.16 ± 2.73 years; 51.1% were male, and 63.1% had a disease duration of ≥3 years. Elevated levels of diabetes-specific disordered eating behaviors were observed in 85.8% of participants. Mean scores were 36.06 ± 15.26 (DEPS-R), 58.86 ± 12.90 (SAS-A), 48.82 ± 12.09 (SAAS), and 35.17 ± 10.61 (CYRM-12). Disordered eating behaviors showed positive correlations with social anxiety and social appearance anxiety and negative correlations with psychological resilience (all p < 0.001). Regression analyses indicated that social anxiety remained independently associated with disordered eating behaviors, whereas social appearance anxiety and psychological resilience did not. Psychological resilience was inversely related to both anxiety measures. Conclusions: Diabetes-specific disordered eating behaviors are common in adolescents with T1D and are closely linked to social anxiety-related factors. Social anxiety appears to be a key associated variable. Although psychological resilience was not independently related to disordered eating behaviors, it showed inverse associations with social anxiety. These findings support integrating routine psychosocial screening and targeted interventions into multidisciplinary diabetes care. Full article

Background/Objectives: Intentional insulin omission (IIO), commonly referred to as diabulimia, is a high-risk behavioural phenomenon observed mainly in adolescents and young adults with type 1 diabetes mellitus (T1D). Defined as the deliberate reduction or omission of insulin to influence body weight, IIO lies at the intersection of metabolic management and eating disorder psychopathology. Despite serious health risks, including diabetic ketoacidosis, microvascular complications, and increased mortality, it remains under-recognised due to stigma, diagnostic ambiguity, and overlap with routine diabetes self-management. This review aimed to examine the prevalence, psychological mechanisms, and clinical consequences of IIO. Methods: On 1 April 2026, we conducted a systematic search of PubMed, Scopus, APA PsycInfo/PsycArticles and Cinahl for studies investigating intentional insulin omission and related metabolic and psychological outcomes in T1D. Clinical and epidemiological studies assessing prevalence, risk factors, and interventions were included. Results: Twenty-nine studies met the inclusion criteria. Prevalence estimates ranged from 20% to 45%, with higher risk among females, adolescents, and individuals experiencing diabetes-related distress or body dissatisfaction. Psychological factors—including fear of weight gain, emotion dysregulation, depressive symptoms, and identity conflicts—were associated with IIO onset and maintenance. IIO was consistently linked to poor glycaemic control, elevated HbA1c levels, and adverse metabolic and psychological outcomes. Screening tools such as the Diabetes Eating Problem Survey–Revised (DEPS-R) may support early identification, while effective management requires integrated multidisciplinary care. Conclusions: Although IIO is not formally classified as an eating disorder in current diagnostic systems, it shares important psychopathological features with eating disorders and may represent a diabetes-specific disordered eating behaviour with life-threatening consequences. Full article

Type 1 diabetes is the most common autoimmune endocrine disorder in children and adolescents, with incidence rising worldwide. Its management demands comprehensive care encompassing glucose monitoring, insulin therapy, and individualized nutritional education to support glycemic control and overall health. Establishing normal eating patterns is pivotal not only for prandial euglycemia but also for reducing the risk of disordered eating behaviors and eating disorders that are more frequently observed in youth with diabetes. Because eating patterns and self-management capabilities vary by developmental stage, interventions must be tailored to the physical, psychological, and social context of each age group. Screening tools such as the Diabetes Eating Problem Survey—Revised (DEPS-R) enable timely identification of at-risk individuals. In this scoping review we present the data from the literature regarding the eating patterns and deviations from infancy to adolescence, report the complications and discuss the challenges and insights for their management. Full article

Background and Objectives: Eating disorders are one of the most widespread health concerns, mainly among adolescents. Children and adolescents with type 1 diabetes mellitus (T1DM) have been reported to have a high prevalence of eating disorders. The aim of our study is to evaluate the risk of diabetes-specific eating disorders in children with T1DM using continuous subcutaneous insulin infusion (CSII), with real-time glycemic data from continuous glucose monitoring (CGM). Materials and Methods: Sixty-four patients (aged 7–18 years) completed the Diabetes Eating Problem Survey-Revised (DEPS-R). The DEPS-R is a diabetes-specific self-report questionnaire to assess diabetes-specific compensatory behaviors. Auxological findings, sex, age, age at diagnosis, hemoglobin A1c (HbA1c) levels, and all CGM data were obtained from their medical records. Results: Although the median DEPS-R score was higher in children and adolescents using CSII compared to those using multiple daily injections (MDIs) (14 vs. 11), the difference was not statistically significant (p = 0.302). The risk of diabetes-specific eating disorders was identified in six patients (30%) using CSII and in nine patients (20.4%) using multiple daily injections (p = 0.403). Interestingly, in the subgroup with poor glycemic control (HbA1c > 9%), DEPS-R scores were significantly lower among those using CSII compared to the MDI group. Pearson correlation analysis demonstrated positive associations between DEPS-R scores and diabetes duration, weight SDS, body mass index (BMI), BMI SDS, HbA1c, mean glucose, Glucose Management Indicator (GMI), time above range (TAR) (very high), and coefficient of variation (CV), while a moderate negative correlation was observed with time in range (TIR). Conclusions: This study showed that the treatment of CSII had a beneficial effect on the risk of eating disorders in patients with poor glycemic control. As well, from this perspective, CSII maintains its status as a potentially beneficial therapeutic approach in diabetes management. Full article

Objectives: The objective of this manuscript is to translate, adapt, and validate an Arabic version of the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire to assess disordered eating behaviors (DEBs) in adolescents with T1D in Saudi Arabia. Additionally, the study sought to estimate the prevalence of DEBs and analyze its associations with glycemic control and diabetes-related complications. Methods: A cross-cultural validation study was conducted following the COSMIN guidelines. The DEPS-R questionnaire was translated into Arabic through forward and backward translation involving expert panels, including psychiatrists, diabetologists, and linguists. A sample of 409 people with type 1 diabetes (PwT1D) (58.4% females) aged 12–20 years was recruited from outpatient diabetes clinics in the five main regions of Saudi Arabia. Participants completed the Arabic DEPS-R and the validated Arabic version of the SCOFF questionnaire. Sociodemographic, anthropometric, and biochemical data were collected, and statistical analyses, including confirmatory factor analysis (CFA) and internal consistency tests, were conducted. Results: The Arabic DEPS-R exhibits strong internal consistency (Cronbach’s alpha = 0.829) and high test–retest reliability (ICC = 0.861), with a CFA supporting a three-factor structure, namely body weight perception, disordered eating behaviors (DEBs), and bulimic tendencies. Notably, higher DEPS-R scores are significantly linked to elevated HbA1c levels, increased BMI, and more frequent insulin use. Alarmingly, 52.8% of participants show high-risk DEB, which is directly associated with poor glycemic control (HbA1c ≥ 8.1%) and a heightened risk of diabetic ketoacidosis (DKA). Conclusions: The Arabic DEPS-R is a valid and reliable tool for screening DEBs among Saudi adolescents with T1D. Findings underscore the necessity for early identification and intervention to mitigate the impact of EDs on diabetes management and overall health outcomes. Full article

Background/Objectives: This study assesses the prevalence of diabulimia in Greek children and adolescents with Type 1 Diabetes Mellitus (T1DM) by using the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire and addresses a gap in the literature on eating disorders (EDs) and disordered eating behaviors (DEBs) in this population. The DEPS-R threshold score of ≥20, although originally established in international studies, has also been applied in Greek adult validation studies. However, it has not yet been formally validated in Greek youth. Methods: Participants aged 9–18 years, diagnosed with T1DM a minimum of one year before the start of the study, were recruited from three pediatric departments in Thessaloniki and were asked to complete the Greek version of the DEPS-R questionnaire. Appropriate statistical analysis was employed to investigate the association of the DEPS-R score with anthropometric, demographic, and glycemic variables derived from the clinical assessment and the patient’s medical records. Results: Girls had significantly higher DEPS-R scores compared with boys. Significant positive associations were observed between the DEPS-R score and both age (r = 0.212, p = 0.020) and Body Mass Index (BMI) (r = 0.419, p < 0.001). A significant association with Glycated Hemoglobin (HbA1c) (r = 0.182, p = 0.047) suggested that poorer glycemic control may be linked to disordered eating, although no significant associations were identified with physical activity or type of insulin therapy. Conclusions: Older age, higher Body Mass Index (BMI) and elevated Glycated Hemoglobin (HbA1c) levels are associated with increased risk of disordered eating in youth with T1DM, especially in girls. Therefore, the implementation of early screening and targeted interventions is imperative. Full article

The effective management of diabetes is a complex issue and may be determined according to numerous patient-dependent and patient-independent factors. This study aimed to analyze the relationship between the place of residence and selected sociodemographic, psychological and diabetes-related parameters in people with type 1 diabetes (T1D). This study was conducted on 419 adults with T1D using nonprobability sampling. The following questionnaires were used: the Diabetes Dietary Guidelines Adherence Index, the Acceptance of Illness Scale, the Sense of Responsibility for Health Scale, the Diabetes Eating Problem Survey-Revised scale, the Eating Attitudes Test and questions on sociodemographic and diabetes-related parameters. People living in rural areas were characterized by a significantly lower age and level of education, a higher incidence of being overweight, a higher glycated hemoglobin concentration, a lower number of glucose measurements during the day and a higher level of acceptance of the disease compared to urban residents. The degree of adherence to dietary recommendations and the sense of responsibility for one’s own health were significantly higher among urban residents. It is necessary to assess barriers to a proper diet and to increase the effectiveness in managing the disease in rural communities. Targeted actions promoting the health of type 1 diabetics need to be developed with particular emphasis on patients from rural areas. Full article

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. Full article

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. Full article

Background: Diabulimia is associated with “resistance to treatment”, impaired glycemic control, and increased risk of diabetic complications. The aim of this study was to explore the possible lifestyle and diet factors associated with diabulimia using the “Diabetes Eating Problem Survey-Revised” (DEPS-R), a questionnaire assessing the risk of diabulimia in patients with T1DM. Methods: 100 outpatients with a diagnosis of T1DM for over a year, from two hospitals in Athens, Greece were asked to complete a questionnaire about their medical history and lifestyle behaviors along with the Eating Attitudes Test (EAT-26), the Beck Depression Scale (BDI-II) and the DEPS-R. Results: Multivariate linear regression analysis showed statistically significant associations between DEPS-R score and HbA1c% levels (b = 4.447, 95% CI 3.220–5.675), sex (male) (b = −4.413, 95% CI −8.778–−0.047, weight perception higher than normal (b = 9.896, 95% CI 5.266–14.526), time spent walking minutes per week (b= −0.019, 95% CI −0.031–−0.006), having received diabetes nutritional education (b = −5.128, 95%CI −10.141–−0.115), eating breakfast (b = −6.441, 95% CI −11.047–−1.835) and having a first relative diagnosed with an eating disorder (b = 6.164, 95%CI 0.030–12.298). The presence of these factors could help highlight the profile of potential individuals at risk of diabulimia and enhance preventive interventions. Full article

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. Full article

Background: People with type 1 diabetes are susceptible to disordered eating behaviors. The American Diabetes Association recommends using the Diabetes Eating Problem Survey-Revised (DEPS-R) to screen them. There is no validated diabetes-specific screening measure in China. The objectives were to adapt DEPS-R into Mandarin Chinese and to test its psychometric properties among youths and adults with type 1 diabetes in China, respectively. Methods: This study was conducted in two phases. Phase 1 included context relevance evaluation and instrument translation. Phase 2 was psychometric testing of reliability and construct validity among 89 youths (8~17 years old) and 61 adults with type 1 diabetes. Result: The Context Relevance Index and Translation Validity Index of this instrument were good. Strong internal consistency reliability correlations and convergent validity were demonstrated among youths and adults. Discussion: The Chinese version of the DEPS-R is a valid and reliable tool for screening disordered eating behaviors in Chinese youths and adults with type 1 diabetes. The Context Relevance Index is advocated to evaluate the difference between the context in which an instrument was originally developed and the target context. Full article

Background: Disordered eating behaviors (DEBs), including diagnosable eating disorders, are quite common and can interfere with optimal type 1 diabetes (T1DM) management. We explored DEBs prevalence in youth with T1DM, proposing news diagnostic subscales, to represent the clinical dimensions associated with feeding and eating disorders (ED); Methods: additionally to SCOFF questionnaire and Diabetes Eating Problem Survey–Revised (DEPS-R), four subscales combined from the original DEPS-R questionnaire were administered to 40 youths with T1DM (15.0 ± 2.6); Results: females showed higher scores than males in DEPS-R original factor 2 (“preoccupations with thinness/weight”, p = 0.024) and in DEPS-R proposed “restriction” factor (p = 0.009). SCOFF scores was correlated with original DEPS-R factors 1 (“maladaptive eating habits”) and 2 (p < 0.001) and with the newly proposed DEPS-R factors: restriction, disinhibition, compensatory behaviors, diabetes management (all p < 0.02). Diabetes management was the only factor related to glycated hemoglobin level (p = 0.006). Patients with high DEPS-R score (≥20) scored higher than patients with low (<20) DEPS-R score in DEPS-R original factors 1 (p < 0.001) and 2 (p = 0.002) as well as in the proposed factors including restriction, disinhibition, diabetes management (all p < 0.02); Conclusions: the complicated nature of DEBs calls for the development target specific questionnaires to be used as screening tools to detect cases of DEBs and exclude non cases. Early recognition of DEBs in adolescents with T1DM is essential for effective prevention and successful treatment. Full article