title: Disturbed eating behaviors in adolescents with type 1 diabetes. How to screen for yellow flags in clinical practice?
abstract: Adolescents with type 1 diabetes are at an increased risk of disturbed eating behaviors (DEBs).
  
  
  
  The aims of this study are to (i) explore the prevalence of DEBs and associated 'yellow flags', and (ii) establish concordance between adolescents-parents and adolescents-clinicians with respect to DEBs.
  
  
  
  Adolescents (11-16 yr) and parents completed questionnaires. A stepwise approach was used to assess DEBs: only adolescents whose answers raised psychological yellow flags for DEBs completed the Diabetes Eating Problems Scale - Revised and questions from the AHEAD study. Parents and clinicians shared their observations regarding possible DEBs. Kruskal-Wallis tests, post hoc Mann-Whitney U test, and chi-squared tests were utilized to examine clinical yellow flags. Cohen's kappa was used to assess concordance.
  
  
  
  Of 103 adolescents participated (51.5% girls), answers of 47 (46.5%) raised psychological yellow flags, indicating body and weight concerns. A total of 8% scored above cut-off for DEBs. Clinical yellow flags were elevated glycated hemoglobin A1c (p = 0.004), older age (p = 0.034), dieting frequency (p = 0.001), reduced quality of life (p = 0.007), less diabetes self-confidence (p = 0.015), worsened diabetes management (p < 0.001), and body dissatisfaction (p < 0.001). Body Mass Index (BMI) z-scores and gender were no yellow flags. Concordance between parents and adolescents was slight (k = 0.126 and 0.141), and clinicians and adolescents was fair (k = 0.332).
  
  
  
  Half of the adolescents reported body and weight concerns, less than 1 in 10 reported DEBs. Screening for yellow flags for DEBs as a part of clinical routine using a stepwise approach and early assistance is recommended to prevent onset or deterioration of DEBs.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.|EMGO + Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Minke Ma
authors.initials: MM
authors.lastname: Eilander
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.|EMGO + Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: de Wit
authors.affiliation: EMGO + Institute for Health and Care Research, Amsterdam, The Netherlands.|Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Rotteveel
authors.affiliation: Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands.
authors.forename: Henk Jan
authors.initials: HJ
authors.lastname: Aanstoot
authors.affiliation: Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Willie M
authors.initials: WM
authors.lastname: Bakker-van Waarde
authors.affiliation: Department of Pediatrics, Juliana Children's Hospital/Haga Hospital, The Hague, The Netherlands.
authors.forename: Euphemia Cam
authors.initials: EC
authors.lastname: Houdijk
authors.affiliation: Department of Pediatrics, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Roos
authors.initials: R
authors.lastname: Nuboer
authors.affiliation: Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands.
authors.forename: Per
authors.initials: P
authors.lastname: Winterdijk
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.|EMGO + Institute for Health and Care Research, Amsterdam, The Netherlands.|Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D057215:Body Dysmorphic Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002652:Child Behavior; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000523:psychology / Q000628:therapy; D042241:Early Diagnosis; D001068:Feeding and Eating Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D019959:Feeding and Eating Disorders of Childhood / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010287:Parent-Child Relations; D010290:Parents; D010349:Patient Compliance; D010817:Physician-Patient Relations; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012649:Self Concept; D000073278:Self-Management
keywords: DINO study; adolescents; disturbed eating behavior; quality of life; type 1 diabetes