Understanding, measuring and treating eating disorders in those with type 1 diabetes

The purpose of this thesis was to explore the nature of Eating Disorders in Type 1 Diabetes. Whether or not Eating Disorders are more prevalent in this demographic is a topic of contention but regardless there is a consensus that those with comorbid Type 1 have considerably worse outcomes and are significantly more difficult to treat. It has been argued that this may be due to a feature unique to this population; insulin omission for weight control. The first aim of this thesis was to systematically review how Eating Disorders have been measured in Type 1 Diabetes, paying particular attention to whether researchers have taken the role of Diabetes regimen and insulin omission into account. Following this a comparison between two Eating Disorder scales, one Diabetes specific the other not, was made in order to compare prevalence rates, to explore which items may be potentially biased and to investigate what the effect of modification may be. The structure of the Diabetes specific scale (the Diabetes Eating Problem Scale Revised) was then explored. The second aim of this thesis was to replicate a pilot study that aimed to explore demographic, psychological and health seeking features of those with Type 1 Diabetes related Eating Disorders. This formed the basis of a structural model whereby psychological and Diabetes specific traits were hypothesised to predict Eating Disorder behaviour and elevated blood glucose levels. A questionnaire built for that study regarding patient attributions was also reanalysed using new data. The final aim was to investigate how Eating Disorders in Type 1 Diabetes have been treated by reviewing literature from the last 2 decades, paying particular attention as to how treatment providers have accommodated the unique needs of those with T1D and whether or not programmes have been successful in relation to both psychological and biological outcomes