The mediating role of appearance-related schema in the pattern of eating attitudes and behaviour in adolescents with Type 1 Diabetes

Deteriorating metabolic control in adolescents with Type 1 Diabetes Mellitus (T1DM) has been closely linked with: the emergence of eating disorders, sub-clinical disordered eating, and treatment non-adherence - namely the use of insulin omission, a unique form of calorie purging behaviour, often referred to as diabulimia. Co-morbidity of T1DM and disordered eating/treatment non-adherence is known to compromise metabolic control, and expedite short and long-term detrimental health outcomes. To most effectively mitigate adverse health outcomes and improve the metabolic control of adolescents with T1DM, a greater understanding of these behaviours, along with precipitating factors, is warranted to permit effective screening and prevention strategies. A systematic literature review was conducted to determine what is currently known about diabulimia, the use of insulin manipulation as a weight management strategy. Fourteen studies were reviewed, all of which found evidence of insulin manipulation for weight control, with rates varying between 1%-37%. The results of the studies were discussed in relation to the methodologies used, aetiological factors and the health consequences of this behaviour. Body dissatisfaction was found to have an aetiological role in the use of insulin manipulation, but was often not addressed rigorously, a finding which was addressed in the research paper. A questionnaire survey of 113 adolescents with and without T1DM was conducted to investigate the role of body image (appearance-related schema) in the pattern of eating attitudes and behaviour. Adolescents living with T1DM were not found to experience greater difficulties with eating or body-image than adolescents living without T1DM. Although no between-group differences were found, 7.7% of adolescents living with T1DM achieved clinical caseness on a measure of eating attitudes and behaviour. Appearance-related schemas were not found to predict disordered eating. Possible explanations, methodological difficulties and implications for future research and clinical practice were discussed.