Patients’ perspectives on screening for disordered eating among adolescents with type 1 diabetes

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity https://doi.org/10.1007/s40519-023-01539-2 (2023) 28:4 RESEARCH Patients’ perspectives on screening for disordered eating among adolescents with type 1 diabetes Caroline Bruun Abild1,2,8 · Annesofie Lunde Jensen1,2 · Rikke Bjerre Lassen1 · Esben Thyssen Vestergaard1,2,3 · Jens Meldgaard Bruun1,2,8 · Kurt Kristensen1,2 · Rene Klinkby Støving4,5,6 · Loa Clausen2,7 Received: 16 November 2022 / Accepted: 29 December 2022 © The Author(s) 2023 Abstract Purpose People with type 1 diabetes have an increased risk of disordered eating (DE) and eating disorders (ED). Screening is recommended however little is known about patients’ perspectives on screening questionnaires. This paper reports qualitative analyses of patients’ perspectives on the questionnaire Diabetes Eating Problem Survey Revised (DEPS-R), including acceptability, attitudes, and cognitive understanding. Research design and methods 15 adolescents with type 1 diabetes between 11 and 18 years, were interviewed. A semistructured format and a qualitative Interpretive Descriptive (ID) methodology was chosen. Results The analyses identified four themes: (1) The Questionnaire, (2) Reframing Diabetes Visits, (3) This is (not) for me, and (4) Out in the Open. The DEPS-R was completed with-in 5–10 min. with no technical difficulties. The questionnaire altered the diabetes visit for some, creating a new dialog, and time for self-reflection. Adolescents appreciated the direct approach in the questionnaire, and showed willingness to complete the questionnaire, when presented to them by a health care professional (HCP). One item in the DEPS-R proved difficult to understand for some participants. Conclusion The study highlights DEPS-R as a clinically relevant screening questionnaire. Completing DEPS-R prior to a consultation opens the door to a consultation that invites the adolescent to address matters of eating behavior. Our findings suggest that systematic screening of DE/ED using the DEPS-R is both accepted and welcomed by adolescents with type 1 diabetes. Future research should focus on a potential update of selected items in DEPS-R. Level of evidence V – qualitative study. Keywords Adolescent · Pediatric · Eating disorder · Eating disorder behavior · Diabetes · Screening tool * Caroline Bruun Abild 1 Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark 2 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark 3 Pediatric Clinic, Regional Hospital Randers, Randers, Denmark 4 Center for Eating Disorders, Odense University Hospital, Odense, Denmark 5 Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark 6 Mental Health Services in the Region of Southern Denmark, Esbjerg, Denmark 7 Department of Child and Adolescent Psychiatry–Research unit, Aarhus University Hospital, Aarhus, Denmark 8 Danish National Center for Obesity, Copenhagen, Denmark Introduction Type 1 diabetes is a chronic auto-immune disease characterized by deterioration of insulin-producing beta cells in the pancreas, leading to insulin depletion and hyperglycemia [1]. Individuals with type 1 diabetes have a 2–threefold increased risk of disordered eating (DE) or eating disorders (ED) [2–7]. Coexisting type 1 diabetes and DE/ED is associated with impaired metabolic control and consequently an increased morbidity and mortality [8–10]. The etiology behind DE/ED in type 1 diabetes is unknown however contributing factors may be insulindependent weight (re)gain after diagnosis, incessant glucose monitoring and subsequent insulin dosage, adding dietary restraint and preoccupation as part of the diabetes management [11–13]. 13 Vol.:(0123456789) 4 Page 2 of 9 Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity ED refers to clinical EDs meeting diagnostic criteria for anorexia nervosa, bulimia nervosa or binge eating disorder[14], whereas DE refers to inappropriate eating behaviors and preoccupation with weight, body shape or eating, however, not yet at a level, frequency, or severity to qualify for a formal ED diagnosis [13]. Insulin manipulation or omission is a diabetes specific weight loss technique that is uniquely applicable to patients with type 1 diabetes. Up to 40% of young women with type 1 diabetes report insulin omission with the purpose of weight loss [10, 15]. Due to this poor prognosis guidelines recommend routinely screening for DE/ED in type 1 diabetes [16, 17], as early intervention may improve the outcome, especially in children and adolescents [18–20]. One of the fundamental principles of screening is that a test should be acceptable to the population [21]. This has to our knowledge never been investigated regarding DE/ED screening in adolescents with type 1 diabetes. Numerous screening tools are available to detect symptoms of DE/ED. However, generic screening tools may estimate the prevalence inaccurately in people living with diabetes, due to the required focus on nutrition, weight, and carbohydrate intake. Furthermore, these tools do not include the aspect of insulin manipulation [3, 22]. Diabetes Eating Problem Survey—Revised (DEPS-R) is a 16 items screening tool to detect DE in diabetes [23]. Higher scores indicate greater pathology, and a score ≥ 20 Likert point is positively correlated with signs of DE [23, 24]. Although reliability and validity of DEPS-R have been extensively tested with acceptable results [25–27], the patients’ perspectives on DEPS-R have never been explored. The aim of this study was to investigate perspectives of adolescents with type 1 diabetes on systematic screening using DEPS-R prior to a yearly visit. This includes their cognitive understanding, experiences completing the questionnaire, as well as their acceptance of time consumption, question content, and utility in the clinical consultation. Methods Study design An explorative, qualitative research approach using individual semi-structured interviews was chosen to explore perspectives, convey attitudes, acceptability, and cognitive understanding of the Danish translation of DEPS-R among adolescents with Type 1 Diabetes [28, 29]. Most answered DEPS-R at home before the visit, expressing that it “was easier to concentrate”, but one filled out the questionnaire in the car going to the clinic. Interpretive Description (ID) served as the methodological framework both regarding design and interpretation [29]. A relevant key element of ID is the importance of clinical 13 (2023) 28:4 relevance and application matching our aim derived from a clinical perspective and intending to improve and inform clinical practice. To ensure both conduct and reporting of the study the CoreQ 32-item checklist was introduced [30]. Participants Participants were recruited from the Pediatric and Adolescents outpatient Clinic at Steno Diabetes Center Aarhus (SDCA). Participants were recruited using purposive samp (...truncated)