Screening for Disordered Eating Behaviors (DEBs) in Adolescents and Young Adults (AYA) With Type 1 Diabetes (T1D): A Scoping Review and U.S. Clinic Screening Survey

Abstract

Adolescents and young adults (AYA) with type 1 diabetes (T1D) are at risk for developing disordered eating behaviors (DEBs). The objectives of the present paper are two-fold. First, the scoping review aims to understand DEB screening in the literature, while the United States (U.S.) Clinic Screening Survey aims to understand DEB screening in practice. Utilizing PubMed and PsycInfo, the terms (1) “eating disorder” OR “anorexia” OR “bulimia” OR “disordered eating” OR “insulin omission” OR “diabulimia” AND (2) “type 1 diabetes” OR “T1D” OR “insulin dependent” were used. Studies were included if participants were between the ages of 10 and 25, written in English, and in peer-reviewed journals between 2010 and 2022. An additional literature search was conducted in June of 2024. A total of 64 reports from 55 unique studies were included. Results of the scoping review found that the Diabetes Eating Problem Survey-Revised (DEPS-R) was the most used screening tool (69%) in various languages. Fiftypediatric T1D providers completed the U.S. Clinic Screening Survey. Approximately 29% of centers reported screening annually for DEBs, and another 43.8% reported screening “as needed” (less than annually). The DEPS-R (32.3%) and SCOFF (17.6%) were the most frequently used screening tools in practice. Providers reported from one to eight (M = 3.2, SD = 1.7) barriers to screening for DEBs in their respective clinics. The number of barriers was related to reports of serving higher proportions of racially/ethnically minoritized (REM) patients. Future research should address barriers to screening for DEBs through system-wide quality improvement (QI) projects.

Implications for Impact Statement

The present study has two main objectives: providing a comprehensive overview of screening for DEBs through a scoping review and gaining a deeper understanding of clinic screening practices for DEBs through a U.S. clinic screening survey. The present study highlights that most studies in the literature and providers in practice screen for disordered eating behaviors using validated tools in pediatric diabetes populations, with the acknowledgment of several barriers. This suggests the opportunities for systems-wide quality improvement initiatives in pediatric diabetes centers.