Brief screening tool for disordered eating in diabetes: internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes

Jessica T Markowitz, Deborah A Butler, Lisa K Volkening, Jeanne E Antisdel, Barbara J Anderson, Lori M B Laffel, Jessica T Markowitz, Deborah A Butler, Lisa K Volkening, Jeanne E Antisdel, Barbara J Anderson, Lori M B Laffel

Abstract

OBJECTIVE To update and validate a diabetes-specific screening tool for disordered eating (the Diabetes Eating Problem Survey [DEPS]) in contemporary youth with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 112 youth with type 1 diabetes, ages 13-19 years, completed the DEPS. Higher scores on the DEPS indicate more disordered eating behaviors. Youth and their parents also completed additional surveys to examine diabetes-specific family conflict, negative affect related to blood glucose monitoring, youth quality of life, and diabetes burden. Clinicians provided data on height, weight, A1C, and insulin dosing. The DEPS was revised into a shorter, updated measure and validated. RESULTS The revised 16-item DEPS (DEPS-R) displayed excellent internal consistency (Cronbach's alpha = 0.86). Construct validity was demonstrated by positive correlations with zBMI (P = 0.01), A1C (P = 0.001), diabetes-specific family conflict (P < 0.005), youth negative affect around blood glucose monitoring (P = 0.001), parental diabetes-specific burden (P = 0.0005), and negative correlations with frequency of blood glucose monitoring (P = 0.03) and quality of life (P < or = 0.002). External validity was confirmed against clinician report of insulin restriction. CONCLUSIONS The DEPS-R is a 16-item diabetes-specific self-report measure of disordered eating that can be completed in <10 min. It demonstrated excellent internal consistency, construct validity, and external validity in this contemporary sample of youth with type 1 diabetes. Future studies should focus on using the DEPS-R to identify high-risk populations for prevention of and early intervention for disordered eating behaviors.

Figures

Figure 1
Figure 1
DEPS-R scores by insulin restrictor category. Significantly more youth identified by their clinician as insulin restrictors scored ≥20 on the DEPS-R compared with nonrestrictors; 41% of insulin restrictors scored ≥20 on the DEPS-R compared with 14% of nonrestrictors (P = 0.002).

References

    1. Nielsen S: Eating disorders in females with type 1 diabetes: an update of a meta-analysis. Eur Eat Disord Rev 2002;10:241–254
    1. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G: Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 2000;320:1563–1566
    1. Colton P, Olmsted M, Daneman D, Rydall A, Rodin G: Disturbed eating behavior and eating disorders in preteen and early teenage girls with type 1 diabetes: a case-controlled study. Diabetes Care 2004;27:1654–1659
    1. Nielsen S, Emborg C, Mølbak AG: Mortality in concurrent type 1 diabetes and anorexia nervosa. Diabetes Care 2002;25:309–312
    1. Domargård A, Särnblad S, Kroon M, Karlsson I, Skeppner G, Aman J: Increased prevalence of overweight in adolescent girls with type 1 diabetes mellitus. Acta Paediatr 1999;88:1223–1228
    1. Bryden KS, Neil A, Mayou RA, Peveler RC, Fairburn CG, Dunger DB: Eating habits, body weight, and insulin misuse: a longitudinal study of teenagers and young adults with type 1 diabetes. Diabetes Care 1999;22:1956–1960
    1. Peveler RC, Bryden KS, Neil HA, Fairburn CG, Mayou RA, Dunger DB, Turner HM: The relationship of disordered eating habits and attitudes to clinical outcomes in young adult females with type 1 diabetes. Diabetes Care 2005;28:84–88
    1. Neumark-Sztainer D, Story M, Resnick MD, Garwick A, Blum RW: Body dissatisfaction and unhealthy weight-control practices among adolescents with and without chronic illness: a population-based study. Arch Pediatr Adolesc Med 1995;149:1330–1335
    1. Peveler RC, Fairburn CG, Boller I, Dunger D: Eating disorders in adolescents with IDDM: a controlled study. Diabetes Care 1992;15:1356–1360
    1. Rydall AC, Rodin GM, Olmsted MP, Devenyi RG, Daneman D: Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 1997;336:1849–1854
    1. Ackard DM, Vik N, Neumark-Sztainer D, Schmitz KH, Hannan P, Jacobs DR, Jr: Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications. Pediatr Diabetes 2008;9:312–319
    1. Polonsky WH, Anderson BJ, Lohrer PA, Aponte JE, Jacobson AM, Cole CF: Insulin omission in women with IDDM. Diabetes Care 1994;17:1178–1185
    1. Goebel-Fabbri AE, Fikkan J, Franko DL, Pearson K, Anderson BJ, Weinger K: Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 2008;31:415–419
    1. Criego A, Crow S, Goebel-Fabbri AE, Kendall D, Parkin C: Eating disorders and diabetes: screening and detection. Diabetes Spectrum 2009;22:143–146
    1. Antisdel J, Laffel LMB, Anderson BJ: Improved detection of eating problems in women with type 1 diabetes using a newly developed survey (Abstract). Diabetes 2001;50 (Suppl. 2):A47
    1. Hood KK, Butler DA, Anderson BJ, Laffel LM: Updated and revised Diabetes Family Conflict Scale. Diabetes Care 2007;30:1764–1769
    1. Hood KK, Butler DA, Volkening LK, Anderson BJ, Laffel LM: The Blood Glucose Monitoring Communication questionnaire: an instrument to measure affect specific to blood glucose monitoring. Diabetes Care 2004;27:2610–2615
    1. Varni JW, Seid M, Rode CA: The PedsQL: measurement model for the Pediatric Quality of Life Inventory. Med Care 1999;37:126–139
    1. Antisdel JE: Diabetes-specific distress among parents of youth with type 1 diabetes (Abstract). Dissertation Abstracts International 2001;61:6123
    1. Ingersoll GM, Marrero DG: A modified quality-of-life measure for youths: psychometric properties. Diabetes Educ 1991;17:114–118
    1. Jacobson AM, Hauser ST, Lavori P, Wolfsdorf JI, Herskowitz RD, Milley JE, Bliss R, Gelfand E, Wertlieb D, Stein J: Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: I. The influence of patient coping and adjustment. J Pediatr Psychol 1990;15:511–526
    1. Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, Schwartz CE: Assessment of diabetes-related distress. Diabetes Care 1995;18:754–760
    1. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL: 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 2002;11:1–190
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text revision. Washington D.C., American Psychiatric Association, 2004.
    1. Fairburn CG, Cooper Z: The Eating Disorder Examination. In Binge Eating: Nature, Assessment, and Treatment. Fairburn CG, Wilson GT. Eds. New York, Guilford Press, 1993, p. 317–360

Source: PubMed

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