Associations between Disordered Eating Behaviors and HbA1c in Young People with Type 1 Diabetes: A Systematic Review and Meta-analysis

  • Authors: Marks K.1,2, Aalders J.3,4, Liu S.5, Broadley M.6, Thastum M.7, Jensen M.8, Ibfelt E.9, Birkebaek N.10,2, Pouwer F.6,11,3
  • Affiliations:
    1. Department of Clinical Medicine - Paediatrics, Aarhus University, Aarhus, Denmark
    2. Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
    3. Steno Diabetes Center Odense, Odense, Denmark
    4. Department of Clinical Research, University of Southern Denmark, Odense, Denmark
    5. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
    6. Department of Psychology, University of Southern Denmark, Odense, Denmark
    7. Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
    8. Department of Economics, Aarhus University, Aarhus, Denmark
    9. The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
    10. Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
    11. Department of Medical Psychology, Amsterdam UMC, The Netherlands
  • Issue: Vol 20, No 4 (2024)
  • Section: Medicine
  • URL: https://modernonco.orscience.ru/1573-3998/article/view/642989
  • DOI: https://doi.org/10.2174/1573399820666230822095939
  • ID: 642989

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Abstract

Background:In type 1 diabetes, disordered eating behaviors (DEB) can adversely impact HbA1c. Diabetes-adapted DEB questionnaires assess intentional insulin omission, whereas generic questionnaires do not. Given the number of studies describing DEB-HbA1c associations published over the past decade, an updated systematic review is warranted.

Objective:The study aimed to examine the associations between DEBs assessed by generic and diabetes- adapted questionnaires (and subscales) and HbA1c among young people (<29 years) with type 1 diabetes.

Methods:A systematic search was conducted in PubMed, Embase, PsycInfo, and CINAHL databases. Observational studies examining associations between DEB as assessed by questionnaires and HbA1c were included. Publication information, DEB and HbA1c characteristics, and DEBHbA1c associations were extracted. Hedges’ g was calculated for mean HbA1c differences between groups with and without DEB.

Results:The systematic search yielded 733 reports, of which 39 reports representing 35 unique studies met the inclusion criteria. Nineteen studies assessing DEB by diabetes-adapted questionnaires (n=5,795) and seven using generic questionnaires (n=2,162) provided data for meta-analysis. For diabetes-adapted questionnaires, DEB was associated with higher HbA1c (g=0.62 CI=0.52; 0.73) with a similar effect size when restricted to validated questionnaires (g=0.61; CI=0.50; 0.73). DEB was not associated with HbA1c for generic questionnaires (g=0.19; CI=-0.17; 0.55), but significantly associated with higher HbA1c for validated generic questionnaires (g=0.32; 95% CI=0.16-0.48). Participant and HbA1c collection characteristics were often inadequately described.

Conclusion:Diabetes-adapted DEB questionnaires should be used in youth with type 1 diabetes because they capture intentional insulin omission and are more strongly associated with HbA1c than generic DEB questionnaires.

About the authors

Kevin Marks

Department of Clinical Medicine - Paediatrics, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark

Author for correspondence.
Email: info@benthamscience.net

Jori Aalders

Steno Diabetes Center Odense, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark

Email: info@benthamscience.net

Shengxin Liu

Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden

Email: info@benthamscience.net

Melanie Broadley

Department of Psychology, University of Southern Denmark, Odense, Denmark

Email: info@benthamscience.net

Mikael Thastum

Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark

Email: info@benthamscience.net

Morten Jensen

Department of Economics, Aarhus University, Aarhus, Denmark

Email: info@benthamscience.net

Else Ibfelt

The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark

Email: info@benthamscience.net

Niels Birkebaek

Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark

Email: info@benthamscience.net

Frans Pouwer

Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, The Netherlands; Steno Diabetes Center Odense, Odense, Denmark

Email: info@benthamscience.net

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