Test of the modified dual pathway model of eating disorders in individuals with type 1 diabetes.

OBJECTIVE: Adolescents and young adults with type 1 diabetes (T1D) demonstrate high rates of disordered eating behaviors (DEBs) and may experience physiological and psychological vulnerabilities not currently included in established risk models of DEBs. This study examined associations among constructs included in the recently proposed T1D-specific modified dual pathway model and examined age as a moderator of these associations. METHOD: Participants included adolescents (n = 307; age M = 15.71, SD = 1.33), young adults (n = 313; age M = 21.20, SD = 2.10), and adults (n = 198; age M = 30.51, SD = 2.81) recruited via the T1D Exchange Clinic Registry. Data were collected from participants' medical records and from self-report questionnaires assessing dietary regimen, dietary restraint, body dissatisfaction, hunger/satiety, diabetes-specific negative affect, and DEBs. Multiple group path modeling was used to test hypotheses. RESULTS: Approximately 31% of participants were at risk for an eating disorder. The original modified dual pathway model had poor model fit. The addition of three empirically defensible paths improved model fit. Diabetes-specific dietary regimen, diabetes-specific negative affect, and hunger/satiety disruption all were associated with DEBs. A fully varying multiple group model by age fit best; however, only the dietary restraint to DEBs pathway demonstrated a distinct pattern across age cohort, which attenuated from the adolescent to the adult cohort. DISCUSSION: This study provides preliminary support for associations proposed in the modified dual pathway model and suggests potential for intervening on disease-specific risk factors of DEBs in a T1D population.

Eating patterns and food intake of persons with type 1 diabetes within the T1D exchange.

AIMS: To identify dietary intake and eating patterns of people with type 1 diabetes from childhood to later adulthood in relation to HbA1c. METHODS: Trained interviewers conducted 24-hour recalls via phone utilizing a multiple pass approach and administered two nutrition questionnaires; 463 participants (or parents of participants) within the T1D Exchange clinic registry were included. Participants were 5 to 81 years with 80-101 participants in five age groups; 56% were female, and 92% were white, with a median diabetes duration of 11.1 years and a median HbA1c of 7.4% [57 mmol/mol]). RESULTS: Those with type 1 diabetes consumed less calories from carbohydrates and more from fats and protein than those in the general population, based on the National Health and Nutrition Examination Survey data. Carbohydrate intake was not correlated with HbA1c levels. Increased fiber intake, more eating occasions, higher Healthy Eating Index scores, and higher nutrition knowledge scores were each associated with lower HbA1c levels. CONCLUSIONS: Food intake, eating patterns and nutrition knowledge are associated with glycemic control across a registry-based cohort of adults and children with type 1 diabetes. Additionally, these data can inform the design of future studies to advance our understanding of nutritional influences on type 1 diabetes self-care and control.

If DSME Were a Pill, Would You Prescribe It?

EDITOR'S NOTE: This address was delivered by Margaret A. Powers, PhD, RD, CDE, President, Health Care & Education, of the American Diabetes Association (ADA), at the ADA's 76th Scientific Sessions in New Orleans, La., on 11 June 2016. Dr. Powers conducts research and has a clinical practice as a registered dietitian and diabetes educator at the International Diabetes Center at Park Nicollet in Minneapolis, Minn. Her research focuses on improving diabetes outcomes, including factors that affect the clinical, psychosocial, and behavioral aspects of diabetes. Dr. Powers has been an ADA volunteer for more than 25 years, including serving as a founding editor of Diabetes Spectrum. She is the lead author of the 2015 joint Position Statement on Diabetes Self-management Education and Support published by the ADA, American Association of Diabetes Educators, and Academy of Nutrition and Dietetics. She is the recipient of the ADA's Outstanding Educator in Diabetes Award and has published research, authored numerous articles and chapters, published five books, and is an international presenter. Dr. Powers holds a doctorate in education with a focus on performance improvement from Capella University. She received her Master of Science from the University of Illinois at Chicago and her Bachelor of Science from Michigan State University. She completed her dietetic internship at Cook County Hospital in Chicago.

Diabetes Distress Among Persons With Type 1 Diabetes.

Purpose The purpose of this study is to evaluate associations between diabetes distress and a range of psychological health behaviors and concerns among persons with type 1 diabetes for the benefit of enhancing early identification and intervention of at-risk individuals. Methods Persons with type 1 diabetes (n = 268; 57.1% female, 91.0% white, 76.8% <18 years of age, average A1C 8.4%) completed the 2-item Diabetes Distress Screening Scale (DDS2) and a battery of psychometrically sound instruments measuring satisfaction with life, self-esteem, self-efficacy, depression, perfectionism, body image satisfaction, dietary restraint and eating, and shape and weight concerns. Each subscale score was compared within age groups (<18 years vs ≥18 years) between groups (diabetes distress level [low, moderate, high]) using analysis of variance (with Bonferroni correction or the Kruskal-Wallis test if the variables were not normally distributed). Results For both age groups, high diabetes distress was independently associated with greater A1C values, higher depression scores and eating, and shape and weight concerns than those with low or moderate distress. For patients <18 years of age, those with high diabetes distress scored lower on measures of satisfaction with life, self-esteem, and self-efficacy and higher on dietary restraint and several areas of perfectionism than those with low or moderate distress. Conclusions Individuals with type 1 diabetes who have high diabetes distress also report higher A1C values and poorer psychological health concerns. A brief diabetes distress questionnaire can help to identify those who need additional screening, education and support, and treatment for overall health and well-being.

Diurnal glucose exposure profiles of patients treated with lixisenatide before breakfast or the main meal of the day: An analysis using continuous glucose monitoring.

BACKGROUND: In the parent study of this analysis, patients with type 2 diabetes received lixisenatide before breakfast or the main meal of the day. This substudy was designed to examine the effect of lixisenatide administered before breakfast or the main meal of the day on continuously assessed 24-hour patient glucose profiles. METHODS: A subset of patients from the parent study underwent 2 14-day periods of continuous glucose monitoring (CGM) at the start and end of the 24-week study. Ambulatory glucose profile analysis was used to measure changes over time in detailed aspects of the glucose profiles. The breakfast group consumed a standardized meal during both CGM periods to determine change in 4-hour glycemic response. RESULTS: Data were available for 69 patients in the substudy, 40 from the original breakfast group and 29 from the main meal group. Between baseline and end of study, mean (standard deviation) total glucose exposure decreased from 4198.1 (652.3) to 3681.2 (699.6) mg/dL*24 h in the breakfast group (P < .0001) and from 4127.9 (876.8) to 3880.9 (1165.0) mg/dL*24 h in the main meal group (P = .0224). For patients included in the substudy, HbA1c decreased by approximately 0.6% in both groups. Mean (standard deviation) 4-hour total glucose exposure fell by 168.9 (158.4) mg/dL*4 h (P < .0001) from baseline. CONCLUSIONS: This analysis demonstrates that lixisenatide has beneficial effects on components of the 24-hour glucose profile, which endure beyond the meal at which it is administered. Continuous glucose monitoring analysis detects changes not captured using HbA1c alone.

2016 Health Care & Education Presidential Address: If DSME Were a Pill, Would You Prescribe It?

This address was delivered by Margaret A. Powers, PhD, RD, CDE, President, Health Care & Education, of the American Diabetes Association (ADA), at the ADA's 76th Scientific Sessions in New Orleans, LA, on 11 June 2016. Dr. Powers conducts research and has a clinical practice as a registered dietitian and diabetes educator at the International Diabetes Center at Park Nicollet in Minneapolis. Her research focuses on improving diabetes outcomes including factors that affect the clinical, psychosocial, and behavioral aspects of diabetes. Dr. Powers has been an ADA volunteer for more than 25 years, including serving as a founding editor of Diabetes Spectrum She is the lead author of the 2015 joint Position Statement on Diabetes Self-management Education and Support published by the ADA, American Association of Diabetes Educators, and Academy of Nutrition and Dietetics. She is the recipient of the ADA's Outstanding Educator in Diabetes Award and has published research, authored numerous articles and chapters, published five books, and is an international presenter. Dr. Powers holds a doctorate in education with a focus on performance improvement from Capella University. She received her Master of Science from the University of Illinois at Chicago and her Bachelor of Science from Michigan State University. She completed her dietetic internship at Cook County Hospital in Chicago.

Development and validation of the Screen for Early Eating Disorder Signs (SEEDS) in persons with type 1 diabetes.

This study's objective was to develop and validate an instrument to identify those at risk of developing an eating disorder (ED) in persons with type 1 diabetes. The Screen for Early Eating Disorder Signs (SEEDS) instrument was developed using a multi-phase process including focus groups, cognitive interviews, and mailed questionnaires. Factor analysis revealed 20 items across three factors (Body Image, Feelings, Quality of Life) demonstrating strong psychometric properties. Scoring guidelines and interpretation are provided. SEEDS is a brief (20-item; 2-5 minutes to complete), self-administered, screen designed for use in clinical practice or research to identify or confirm suspicions of ED risk and does not include weight-control behavior items.

Eating disorders in persons with type 1 diabetes: A focus group investigation of early eating disorder risk.

Through focus groups, we examined the development and maintenance of an eating disorder in 16 females with type 1 diabetes and an eating disorder. The quotes and qualitative data summaries provide rich insights into understanding why those with type 1 diabetes are at increased risk for eating disorders. Content analyses revealed five themes pertinent to the dual diagnosis (feeling different, difficulty with control/coping, body image, feelings, and quality of life) of which four themes were relevant to eating disorder development. Findings support early identification of those at risk and inform interventions to mitigate development of an eating disorder.