Disturbed eating behaviors in adolescents with type 1 diabetes. How to screen for yellow flags in clinical practice?

Background: Adolescents with type 1 diabetes are at an increased risk of disturbed eating behaviors (DEBs). Objective: The aims of this study are to (i) explore the prevalence of DEBs and associated yellow flags', and (ii) establish concordance between adolescents-parents and adolescents-clinicians with respect to DEBs. Methods: Adolescents (11-16yr) and parents completed questionnaires. A stepwise approach was used to assess DEBs: only adolescents whose answers raised psychological yellow flags for DEBs completed the Diabetes Eating Problems Scale-Revised and questions from the AHEAD study. Parents and clinicians shared their observations regarding possible DEBs. Kruskal-Wallis tests, post hoc Mann-Whitney U test, and chi-squared tests were utilized to examine clinical yellow flags. Cohen's kappa was used to assess concordance. Results: Of 103 adolescents participated (51.5% girls), answers of 47 (46.5%) raised psychological yellow flags, indicating body and weight concerns. A total of 8% scored above cut-off for DEBs. Clinical yellow flags were elevated glycated hemoglobin A1c (p=0.004), older age (p=0.034), dieting frequency (p=0.001), reduced quality of life (p=0.007), less diabetes self-confidence (p=0.015), worsened diabetes management (p Discussion: Half of the adolescents reported body and weight concerns, less than 1 in 10 reported DEBs. Screening for yellow flags for DEBs as a part of clinical routine using a stepwise approach and early assistance is recommended to prevent onset or deterioration of DEBs