medwireNews: Research shows that intervening to improve the diet quality of adolescents with type 1 diabetes does not exacerbate disordered eating behavior (DEB).
The 18-month behavioral intervention had been previously shown to improve diet quality in a randomized controlled trial in this population. This secondary analysis focused on 90 participants who were aged at least 13 years old during the trial and completed the Diabetes Eating Problem Survey-Revised (DEPS-R). Their average DEPS-R score was 12.4 out of a possible 80, with individual scores ranging from 0 to 56.
These scores did not significantly change over the course of the intervention, say Miriam Eisenberg Colman (Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA) and study co-authors.
“The intervention aimed to facilitate a positive approach to healthful eating by encouraging increased whole plant food intake rather than dietary restriction and by focusing on general benefits of healthful eating rather than weight-related issues,” they observe in Diabetes Care.
However, they also found that “even at the subclinical levels seen in this sample,” higher DEB was associated with poorer glycemic control over time.
Higher DEPS-R scores were significantly associated with higher glycated hemoglobin, higher average glucose on masked continuous glucose monitoring (CGM), and a greater proportion of time spent in hyperglycemia (glucose >180 mg/dL). It was also associated with lower levels of 1,5-anhydroglucitol, a monosaccharide whose levels decrease during hyperglycemia.
Moreover, patients with above-median DEPS-R scores had high baseline glucose levels, at around 175 mg/dL and about 40% of time spent in hyperglycemia, and this did not change during follow-up, whereas patients with lower scores had baseline glucose of around 140 mg/dL with about 23% of time spent in hyperglycemia, and showed the deterioration of glycemic control over time usually seen in this age group.
The poorer glycemic control in patients with higher DEPS-R scores “has important long-term clinical ramifications,” say the researchers, “since poor glycemic control in adolescence is associated with poor glycemic control in young adulthood and an accelerated onset of long-term health complications.”
They stress: “As such, identifying and reducing DEB in this population at a younger age may mitigate its adverse effects.”
However, higher DEPS-R scores were not associated with time spent in hypoglycemia (<70 mg/dL) or with two indicators of glycemic variability – the standard deviation of CGM values and mean amplitude of glycemic excursions.
The absence of these associations in the presence of a relationship with chronic hyperglycemia suggests “that DEB may be related to intentional insulin omission to increase glycosuria and facilitate unsafe weight loss,” says the team, adding that hyperglycemia may therefore be a better warning sign of DEB in these patients.
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