title: Developing a theoretical maintenance model for disordered eating in Type 1 diabetes.
abstract: BACKGROUND
  According to the literature, eating disorders are an increasing problem for more than a quarter of people with Type 1 diabetes and they are associated with accentuated diabetic complications. The clinical outcomes in this group when given standard eating disorder treatments are disappointing. The Medical Research Council guidelines for developing complex interventions suggest that the first step is to develop a theoretical model.
  
  
  OBJECTIVE
  To review existing literature to build a theoretical maintenance model for disordered eating in people with Type 1 diabetes.
  
  
  METHODS
  The literature in diabetes relating to models of eating disorder (Fairburn's transdiagnostic model and the dual pathway model) and food addiction was examined and assimilated.
  
  
  RESULTS
  The elements common to all eating disorder models include weight/shape concern and problems with mood regulation. The predisposing traits of perfectionism, low self-esteem and low body esteem and the interpersonal difficulties from the transdiagnostic model are also relevant to diabetes. The differences include the use of insulin mismanagement to compensate for breaking eating rules and the consequential wide variations in plasma glucose that may predispose to 'food addiction'. Eating disorder symptoms elicit emotionally driven reactions and behaviours from others close to the individual affected and these are accentuated in the context of diabetes.
  
  
  CONCLUSIONS
  The next stage is to test the assumptions within the maintenance model with experimental medicine studies to facilitate the development of new technologies aimed at increasing inhibitory processes and moderating environmental triggers.
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London.|Psychiatry Department, South London and Maudsley NHS Foundation Trust, London.
authors.forename: J
authors.initials: J
authors.lastname: Treasure
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London.|Psychiatry Department, South London and Maudsley NHS Foundation Trust, London.
authors.forename: C
authors.initials: C
authors.lastname: Kan
authors.affiliation: Psychiatry Department, South London and Maudsley NHS Foundation Trust, London.
authors.forename: L
authors.initials: L
authors.lastname: Stephenson
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London.
authors.forename: E
authors.initials: E
authors.lastname: Warren
authors.affiliation: Diabetes Department, King's College Hospital, London.
authors.forename: E
authors.initials: E
authors.lastname: Smith
authors.affiliation: Diabetes Department, University of Sheffield, Sheffield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Heller
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London.|Psychiatry Department, South London and Maudsley NHS Foundation Trust, London.|Diabetes Department, King's College Hospital, London.
authors.forename: K
authors.initials: K
authors.lastname: Ismail
mesh_terms: D000293:Adolescent; D000818:Animals; D001828:Body Image / Q000523:psychology; D000068959:Body Weight Maintenance; D002648:Child; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy / Q000523:psychology*; D003927:Diet, Diabetic; D019959:Feeding and Eating Disorders of Childhood / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008960:Models, Psychological; D010349:Patient Compliance; D057285:Precision Medicine; D000297:Psychology, Adolescent; D002666:Psychology, Child; D012649:Self Concept
chemical_list: D007004:Hypoglycemic Agents