Propper-Lewinsohn Tamar, Shalitin Shlomit, Gillon-Keren Michal, Yackobovitch-Gavan Michal, Liberman Alon, Phillip Moshe, Elran-Barak Roni
The Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel.
School of Public Health, University of Haifa, Haifa, Israel.
Diabetes Technol Ther. 2025 Feb;27(2):113-120. doi: 10.1089/dia.2024.0267. Epub 2024 Sep 25.
Disordered eating behaviors (DEB) are common among individuals with type 1 diabetes (T1D). Glycemic variability, potentially harmful in T1D, may reveal distinct characteristics between those with higher versus lower variability, particularly concerning DEB. Our aim was to evaluate the prevalence of DEB and associated risk factors among adolescents and young adults with T1D and to investigate unique factors associated with DEB across different levels of glycemic variability. An observational, cross-sectional study was conducted with 147 individuals with T1D, aged 13-21 years. Data were collected from medical charts, personal technological devices for assessing glycemic variability, and self-reported questionnaires, including assessments of DEB. DEB were found in 62 (42.1%) individuals, and 41.5% achieved the glycemic variability (% coefficient of variation) target ≤36%. Among individuals with low glycemic variability, DEB were positively associated with diabetes distress (odds ratio [OR]: 1.14 [95% confidence interval or CI: 1.05-1.22], < 0.001), longer diabetes duration (OR: 1.34 [95% CI: 1.05-1.70], = 0.016) and lower socioeconomic-status (OR: 0.53 [95% CI: 0.31-0.90], = 0.019). Among those with high glycemic variability, body mass index Z score (OR: 3.82 [95% CI: 1.48-9.85], = 0.005), HbA1c (OR: 4.12 [95% CI: 1.33-12.80], = 0.014), disinhibited eating (OR: 1.57 [95% CI: 1.14-2.15], = 0.005), and tendency to lower socioeconomic status (OR: 0.75 [95% CI: 0.56-1.01], = 0.065). DEB are prevalent among adolescents and young adults with T1D and are associated with various risk factors. Factors associated with DEB vary across different levels of glycemic variability. Both low and high glycemic variability are associated with specific risk factors for DEB. One notable risk factor is diabetes-specific disinhibited eating among individuals with high glycemic variability, in contrast to those with low glycemic variability. Given these different risk factors, it may be prudent to adjust intervention programs to reduce DEB among T1D adolescents according to their glycemic variability levels.
饮食紊乱行为（DEB）在1型糖尿病（T1D）患者中很常见。血糖变异性在T1D中可能有害，在血糖变异性较高和较低的患者之间可能表现出不同特征，尤其是在饮食紊乱行为方面。我们的目的是评估T1D青少年和青年中饮食紊乱行为的患病率及相关危险因素，并调查不同血糖变异性水平下与饮食紊乱行为相关的独特因素。对147名年龄在13 - 21岁的T1D患者进行了一项观察性横断面研究。数据收集自病历、用于评估血糖变异性的个人技术设备以及自我报告问卷，包括饮食紊乱行为评估。在62名（42.1%）个体中发现了饮食紊乱行为，41.5%的人达到了血糖变异性（变异系数百分比）目标≤36%。在血糖变异性低的个体中，饮食紊乱行为与糖尿病困扰呈正相关（优势比[OR]：1.14[95%置信区间或CI：1.05 - 1.22]，P < 0.001）、糖尿病病程较长（OR：1.34[95%CI：1.05 - 1.70]，P = 0.016）以及社会经济地位较低（OR：0.53[95%CI：0.31 - 0.90]，P = 0.019）。在血糖变异性高的个体中，体重指数Z评分（OR：3.82[95%CI：1.48 - 9.85]，P = 0.005）、糖化血红蛋白（OR：4.12[95%CI：1.33 - 12.80]，P = 0.014）、无节制饮食（OR：1.57[95%CI：1.14 - 2.15]，P = 0.005）以及社会经济地位有降低趋势（OR：0.75[95%CI：0.56 - 1.01]，P = 0.065）。饮食紊乱行为在T1D青少年和青年中普遍存在，并与多种危险因素相关。与饮食紊乱行为相关的因素在不同血糖变异性水平上有所不同。血糖变异性低和高均与饮食紊乱行为的特定危险因素相关。一个显著的危险因素是血糖变异性高的个体中存在糖尿病特异性的无节制饮食，这与血糖变异性低的个体形成对比。鉴于这些不同的危险因素，根据血糖变异性水平调整干预计划以减少T1D青少年中的饮食紊乱行为可能是谨慎的做法。
