Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: an exploratory study

Abstract

Background Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed to explore the prevalence of DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls during the COVID-19 lockdown. Methods In a cross-sectional study, 138 children and adolescents with T1D (aged 8.01–19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed an online survey about eating behaviors (ChEAT and EAT-26), anthropometric characteristics, and clinical characteristics. Results 8.69% (N = 12) of participants with T1D and 13.4% (N = 37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients—whether children (total ChEAT score F(1, 157) = .104, p = .748) or adolescents (total EAT-26 score F(1, 255) = .135, p = .731)—and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (p < .0001), while HbA1c values remained unchanged (p = .110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138) = 20.411, p < .0001, η2 = .132, controls: F(1, 276) = 18.271, p < .0001, η2 = .063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores. Conclusions This exploratory study suggested that children and adolescents with T1D did not experience more DEB symptoms during the COVID-19 lockdown compared to healthy controls. Results revealed DEBs as more of a female adolescent developmental issue rather than a result of the challenges of living with a chronic illness under quarantine measures. Possible effects of parental pressure on their children’s eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed.

A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

“…The first theme identified was the prevalence of possible eating disorder cases among non‐clinical samples during the pandemic. Eleven studies (participant n s = 120–5,378) investigated this theme by estimating the proportion of participants scoring above an established clinical cut‐off on a self‐report assessment (Alessi et al, 2020 ; Buckley et al, 2021 ; Cecchetto et al, 2021 ; Chan & Chiu, 2021 ; Christensen et al, 2021 ; Flaudias et al, 2020 ; Kohls et al, 2021 ; Racine et al, 2021 ; Thompson & Bardone‐Cone, 2021 ; Troncone et al, 2020 ; Trott et al, 2021 ). None of the samples was representative of the wider population, nor were sampling weights applied in any study in attempts to generalize to the wider population.…”

Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control

“…The association between T1D and DEB could be attributed to the presence of several risk factors for DEB in T1D, like lifelong insulin therapy, attendant weight gain, food preoccupation (e.g., carbohydrate counting), low self‐esteem, and depression [ 37 ]. Weight gain during puberty is exacerbated in adolescents with T1D on intensified insulin therapy which can lead to DEB [ 38 ].…”

Impact of COVID-19 lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 and type 2 diabetes mellitus

“…T1DM children and adolescents in India [6] and Saudi Arabia [7], T1DM Japanese adults [8], and T2DM Turkish adults [9] were reported to have worsening of glycaemic control. However, generally, glycaemic control was reported to be unchanged in most children and youths with T1DM [10][11][12][13]. To our knowledge, there was no reported study on the impact of COVID-19 lockdown in adolescents with T2DM.…”