Eating Disorders and Diabetes: Facing the Dual Challenge

Designing a regional clinical service for people with early-onset type 2 diabetes in England

AIMS

To design a regional clinical service for people with early-onset type 2 diabetes (EOT2D) in Leicester, Leicestershire and Rutland (England).

METHODS

A literature search was undertaken to identify important considerations. A working group of key stakeholders was formed to design a triage system and service pathway. Electronic medical records (EMRs) were searched (15th November 2023) to assess feasibility of the pathway and adapt accordingly.

RESULTS

A literature search identified important considerations: High risk of complications; large proportion from minority ethnic and socioeconomically deprived backgrounds; significant psychological burden; stigma and other social challenges; and misclassification and miscoding. Novel clinical risk criteria were developed, implementable in EMRs, to match intervention-intensity to clinical need. Specialist clinics were planned, one for people at the highest-clinical risk, another for women with adverse perinatal risk factors. A healthcare professional training package was developed to increase awareness of the unmet clinical needs of people with EOT2D and to upskill in provision of holistic care. Subsequent EMR searches supported the need for our service. Due to the large numbers with HbA1c ≥86mmol/mol (10.0%; n=299; 10.8% of total), these people were prioritised for clinic access. We opted for specialist nurse/educator support to practices with clustering of patients and to financially incentivise referrals from primary care into services.

CONCLUSIONS

We showcase a service specifically for people with EOT2D based on the literature, a broad range of stakeholder involvement and utilising a locally-sourced data-driven approach. We further discuss areas for development and recommendations based on the challenges we encountered.

Investigation of food cravings in individuals with type 2 diabetes: A hierarchical regression analysis

AIMS

The aim was to determine food cravings and associated variables in patients with type 2 diabetes.

METHODS

204 type 2 diabetes patients were enrolled in the cross-sectional study between February 16, 2024 and June 16, 2024. Data were collected face-to-face using personal information form, Food Cravings Scale and Diabetes Awareness and Acceptance Scale. Number, percentage, mean, standard deviation and minimum-maximum values, hierarchical regression analysis and pearson correlation test were used to analyze the data. The statistical significance level was assumed to be p < 0.05.

RESULTS

The mean score on the food cravings scale was found to be 23.52 ± 19.44. Hierarchical regression analysis revealed that living alone, increased body mass index, alcohol consumption and hospitalization increased the food cravings in patients with type 2 diabetes. It was also found that the use of a diabetes-specific diet by participants, regular check-ups and high diabetes awareness and acceptance reduced the food cravings.

CONCLUSIONS

It has been shown that managing type 2 diabetes is a dynamic and multidimensional process that is influenced by the desire to eat, awareness of diabetes, knowledge and practices related to diabetes.

Shedding light on eating disorders in adolescents with type 1 diabetes: insights and implications

Eating disorders (EDs) are complex medical conditions that pose a considerable health burden for individuals with type 1 diabetes mellitus (T1DM). EDs in individuals with T1DM are linked to poor metabolic control, which heightens the risk of diabetes complications. Consequently, regular screening for EDs is essential. This study investigates the prevalence of EDs in adolescents with T1DM, investigating the associations with diabetes duration, pubertal stage, glycemic control, and diabetes-related complications. In this cross-sectional study, 350 adolescents (155 males, 195 females) with T1DM, aged 12-18, were recruited from Mansoura University Children's Hospital. Participants completed the Diabetes Eating Problem Survey-Revised (DEPS-R) questionnaire, with scores ≥ 20 prompting clinical interviews to confirm EDs. Clinical data, including HbA1c, BMI, and body composition, were analyzed. Socioeconomic status (SES) and family factors were assessed. The prevalence of EDs was 22.6%, including other specified feeding or eating disorders (OSFED) (68.4%), binge eating (11.4%), bulimia nervosa (7.6%), avoidant restrictive (7.6%), and anorexia nervosa (5.1%). Binary logistic regression analysis showed that the significant predictors of ED in the study cohort were diabetes duration (OR = 1.75 (1.66-1.84), p < 0.001), and HbA1c (OR = 5.94 (2.4-14.6), p < 0.001). Conclusions: Adolescents with EDs had higher (SES), more family conflicts, longer diabetes duration, and were more prone to diabetic nephropathy and poor glycemic control. Screening for EDs is recommended from pre-adolescence through early adulthood. What Is Known: • Adolescents with T1DM are more vulnerable to develop EDs compared to their peers without T1DM What Is New: • The DEPS-R and DSM-V were useful clinical tools for screening and for diagnosis of EDs respectively among adolescents with T1DM • We advise to screen for EDs in adolescents with T1DM who aged around 13.6 years, at Tanner stage 3, with duration of T1DM >5 years, and/or with HbA1c >7.5.

Unveiling the Therapeutic Potential of the Second-Generation Incretin Analogs Semaglutide and Tirzepatide in Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic beta cells, resulting in the lifelong need for exogenous insulin. Over the last few years, overweight and obesity have recently emerged as growing health issues also afflicting patients with T1D. In this context, the term "double diabetes" has been coined to indicate patients with T1D who have a family history of type 2 diabetes mellitus (T2D) and/or patients with T1D who are affected by insulin resistance and/or overweight/obesity and/or metabolic syndrome. At the same time, the use of second-generation incretin analogs semaglutide and tirzepatide has substantially increased on a global scale over the last few years, given the remarkable clinical benefits of these drugs (in terms of glucose control and weight loss) in patients with T2D and/or overweight/obesity. Although the glucagon-like peptide-1 (GLP-1) receptor agonists and the novel dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 receptor agonist tirzepatide are currently not approved for the treatment of T1D, a growing body of evidence over the last few years has shown that these medications may serve as valid add-on treatments to insulin with substantial efficacy in improving glucose control, promoting weight loss, preserving residual beta-cell function and providing other beneficial metabolic effects in patients with T1D, double diabetes and latent autoimmune diabetes in adults (LADA). This manuscript aims to comprehensively review the currently available literature (mostly consisting of real-world studies) regarding the safety and therapeutic use (for different purposes) of semaglutide and tirzepatide in patients with T1D (at different stages of the disease), double diabetes and LADA.

From Childhood Interpersonal Trauma to Binge Eating in Adults: Unraveling the Role of Personality and Maladaptive Regulation

Background/Objectives: Binge eating (BE) is associated with physical and psychological consequences, such as obesity and reduced quality of life. The relationship between binge eating and childhood experiences of interpersonal trauma has been explored, yet few studies focus on the processes that may explain this association. In this regard, some personality traits and maladaptive cognitive-emotional regulation may help explain this relationship, as they have been associated, respectively, with BE and childhood interpersonal trauma. The purpose of this study is to explore the complex processes that link childhood interpersonal trauma and BE in a French-Canadian clinical adult population with obesity (BMI ≥ 30 kg/m2). Methods: This cross-sectional study included 148 participants aged 21 to 72, predominantly women of White ethnic background with a university degree, who were seeking treatment for eating or weight-related issues. They completed self-report questionnaires assessing maltreatment and bullying, BE, maladaptive cognitive-emotional regulation, and personality. Two multiple mediation models were tested to examine the indirect effects of personality and maladaptive regulation in the relationship between bullying and BE, as well as between maltreatment and BE. Results: The results revealed a significant indirect relationship between maltreatment and binge eating (BE), with personality traits and maladaptive cognitive-emotional regulation partially explaining this association. No direct effect was found for bullying, but a significant total indirect effect indicated that personality traits and maladaptive cognitive-emotional regulation play a mediating role in the relationship between bullying and BE. Finaly, self-directedness was found as a unique and significant contributor in both mediation models. Conclusions: This study draws attention to the multiple contributing factors in the relationship between interpersonal trauma and BE in adults with obesity. Further research is needed to gain a deeper understanding of the role of personality and maladaptive cognitive-emotional regulation in this relationship by focusing on individuals' experiences.

Food-Related Behavioral Patterns in Patients with Inflammatory Bowel Diseases: The Role of Food Involvement and Health Engagement

Nutrition has been acknowledged as crucial in IBD and is relevant to patients' motives behind food choices, which are affected by health engagement (HE) and food involvement (FI). This study aimed to profile IBD patients according to their levels of health engagement and food involvement to identify patterns of different motives behind food choices, particularly regarding the use of food to regulate mood. A cross-sectional study was conducted with 890 Italian IBD patients who completed an online survey in April 2021. We measured health engagement, food involvement, motives behind food choices, emotional states, and food-related quality of life (Fr-QoL). K-means cluster analysis was performed to identify participants with similar levels of health engagement and food involvement. Four clusters were identified: "Health-conscious (high HE, low FI)", "Balanced (high HE, high FI)", "Hedonist (high FI, low HE)", and "Careless (low FI, low HE)". Clusters with high FI are inclined toward seeking pleasurable food, but when supported with high health engagement, individuals were less prone to use food to manage mood. Groups with higher health engagement demonstrated lower hospitalization rates and relapses and better Fr-QoL. Profiling IBD patients regarding FI and HE could aid clinicians in identifying individuals at greater risk of maladaptive food-related behaviors.

Mindful Eating and Current Glycemic Control in Patients With Type 2 Diabetes

Objective Lifestyle adjustments are essential in the management of type 2 diabetes mellitus (T2DM). Mindful eating involves being more attentive to and aware of meals. This study aimed to investigate the relationship between mindful eating and glycemic control, as well as body mass index (BMI), in people with T2DM. Materials and methods This cross-sectional study included 448 participants who had been diagnosed with T2DM for at least six months. The participants were categorized into three groups based on their HbA1c levels. The Turkish adaptation of the Mindful Eating Questionnaire (MEQ-30) was employed to assess levels of mindful eating behavior. Obesity was defined as a BMI ≥ 30. Anthropometric measurements, laboratory tests, and questionnaire responses were also collected. Results Participants with well-controlled diabetes (HbA1c ≤7%) demonstrated significantly higher scores on the MEQ-30 and its various subgroups in comparison to those with poorly controlled diabetes (HbA1c >9%). The suboptimal glycemic control groups exhibited noticeable variations in mindful eating behaviors. Moreover, participants with lower BMIs displayed stronger inclinations toward mindful eating. Weak negative correlations were observed between BMI and specific MEQ-30 subgroups. Notably, subgroups such as emotional eating, eating control, eating discipline, and interference demonstrated weak negative correlations with the HbA1c levels. Conclusion  Higher levels of mindful eating were associated with lower levels of HbA1c and BMI, indicating that incorporating mindful eating practices may present promising advantages for individuals diagnosed with type 2 diabetes, specifically in terms of glycemic control and weight management.

Eating Disorders: Assessing Its Prevalence and Pattern Among Adults With Type 2 Diabetes

BACKGROUND

Eating disorders (EDs) are severe and multifaceted mental health issues that affect a person's perception of their body weight in relationship with food. Existing evidence shows that EDs significantly affect the physical and emotional health of individuals with Type-2 Diabetes (T2D) and are associated with impaired metabolic control and a high risk of medical complications, including higher mortality rates. However, there is a paucity of research looking into the prevalence of EDs.

OBJECTIVE

A cross-sectional study was conducted to map the prevalence of EDs and to assess its pattern among adults with T2D from Ahmedabad City, Gujarat, India.

METHODOLOGY

Two hundred fifty-four T2D individuals aged 30-60 were enrolled in the study. A questionnaire was developed using the Sick, Control, One, Fat, Food (SCOFF) questionnaire and a five-question screening tool intended to identify the possibility of EDs as well as the Eating Disorder Examination-Questionnaire (EDEQ), which is used to identify the pattern of EDs with subscales like Restraint, Eating Concern, Shape Concern, and Weight Concern. Written informed consent was obtained from all participants. Descriptive statistics, Pearson's Correlation, and Logistic Regression analysis were used. A p-value of < 0.05 was considered significant.

RESULTS

 The results revealed that 90 (35%) of the total participants were at a high risk of EDs. Among these, 54 (21% of the total population) were males, and 36 (14% of total participants) were females. There was a mild statistically significant negative correlation between age and exercise with the presence of ED (r = -0.151, p = 0.016 and r = -0.186, p = 0.003, respectively), while education showed a significant positive correlation (r = 0.150, p = 0.017). Males had significantly higher scores for eating concerns than females (19.75±4.88 vs 17.88±5.92; p = 0.008). The logistic regression model revealed that education was a significant predictor of EDs (OD = 1.47, 95% CI 1.00-2.16 and p = 0.04).

CONCLUSION

The study identified that people with T2D are at risk of EDs, and eating concerns worry them the most. Thus, counseling sessions should focus on identifying the determinants of EDs and educating the patients regarding quality eating. This will have implications in addressing the other morbidities as well as health risks related to BMI; especially obesity as it is more prevalent in the T2D population.