Associations between disordered eating behaviour, diabetes distress and emotion regulation strategies in adults with type 1 diabetes: Results from a Dutch-Italian cross-sectional study

Aims: Disordered eating behaviour (DEB) and diabetes distress are prevalent in adults with type 1 diabetes (T1D). Emotion regulation strategies, such as cognitive reappraisal and expressive suppression, are associated with DEB and managing stress in general. Here we examine the associations between DEB, diabetes distress, and emotion regulation strategies in the context of T1D. Methods: Adults with T1D in The Netherlands and Italy completed an online survey, covering DEB (DEPS--R), diabetes distress (PAID--5), and emotion regulation strategies (ERQ). Associations between DEB, diabetes distress, and emotion regulation strategies were examined using path analysis. Results: N = 291 participants completed the survey (78.9% women, 39 +/- 13 years, HbA1c: 55 +/- 16 mmol/mol (7.2% [3.6%]); TIR: 66% +/- 25). N = 79 participants (27.1%) reported DEB (DEPS-R >= 20) and n = 159 participants (54.6%) reported elevated diabetes distress (PAID-5 >= 8). The path analysis, with small--to--medium effect sizes, revealed that more diabetes distress was associated with more DEB (beta = 0.23, 95% CI [0.13, 0.34]). Less diabetes distress was associated with more use of cognitive reappraisal (beta = -0.24, 95% CI [-0.36, -0.12]). More DEB was associated with more use of expressive suppression (beta = 0.14, 95% CI [0.04, 0.24]). Conclusions: This cross--sectional study suggests an association between DEB and diabetes distress, between cognitive reappraisal and less diabetes distress and between expressive suppression and more DEB. The results suggest that it may prove beneficial to prioritize strengthening emotion regulation strategies in interventions for people with T1D and DEB. Future research should help clarify causality with regard to emotion regulation and DEB in adults with T1D.