Correlates of disordered eating and insulin restriction behavior and its association with psychological health in Taiwanese youths with diabetes mellitus

BackgroundAdolescents and young adults (AYAs) with diabetes mellitus (DM) are prone to eating disorders that may worsen metabolic control. This study investigated the clinical and behavioral correlates of disordered eating and insulin restriction (DE/IR) behavior and its association with psychological health among AYAs with DM.MethodsWe enrolled patients with DM aged 10-30 years receiving insulin treatment in a tertiary medical center from 2019 to 2021. After obtaining informed consent, we assessed various visit-to-visit HbA1c measures indicating glycemic control, DE/IR behavior using the modified SCOFF questionnaire, weight-control practices (e.g., self-medication, induced vomiting, and over-exercising), and anxious and depressive symptoms using the Hospital Anxiety and Depression Scale. Correlation and hierarchical regression analyses were applied to understand the clinical and behavioral correlates of DE/IR behavior and its association with anxiety and depression.ResultsAmong the 110 patients with type 1 and type 2 DM recruited, we found 17.6% restricting insulin use and 6.3% self-medicating for weight control (higher in type 2 DM than type 1 DM). Hierarchical regression analyses showed HbA1c standard deviation (odds ratio = 2.18, [95% confidence interval 1.07-4.42]), body image (1.83, [1.05-3.20]), and dieting (4.74, [1.70-13.23]) associated with DE/IR behavior. Moreover, DE/IR behavior was further associated with anxiety (1.17 [1.08-1.27]) and depression (1.12 [1.03-1.22]).ConclusionDE/IR behavior is not uncommon among AYAs with DM, particularly those with type 2 DM, and may be associated with anxiety and depressive symptoms. In addition, HbA1c variability is correlated with DE/IR behavior, and the clinical implications need further exploration. While young patients with diabetes mellitus (DM) are prone to eating disorders that may worsen metabolic control, early detection and appropriate intervention of comorbid emotional and behavioral symptoms are urged when providing diabetes care to this vulnerable age group. Having observed an increasing trend of eating disorders in the general population in Taiwan, we aimed to investigate clinical and behavioral correlates of disordered eating and insulin restriction behavior and its association with psychological health in a clinical sample of youths with DM. We found that 17.6% of the young patients with DM restricted insulin use, and 6.3% self-medicated for weight control. Fluctuating glucose levels and body image issues were found to be correlated with disordered eating and insulin restriction behaviors, which were also significantly linked to risks for anxiety and depression. These findings may warrant scrutiny in assessing eating behavior and insulin use among young patients with DM in East Asian settings.