Study Examines T1D Eating Patterns of Youth After COVID-19 Lockdowns in Italy

Type 1 diabetes (T1D) has been associated with psychosocial and eating problems in young people, leading researchers to question the effect that stress related to lockdowns during the COVID-19 pandemic might have had on children and adolescents with T1D. A study published in the Journal of Clinical Psychology in Medical Settings found that the ongoing stress of the pandemic may not have significantly affected eating behaviors of youth patients with T1D.

Past studies suggest that young patients with T1D may find managing stressful situations more challenging than healthy children and adolescents, and the COVID-19 pandemic placed a significant amount of stress on patients with diabetes. Studies of adult T1D patients have found that the pandemic carried a significant psychological burden, including emotional distress and sleeping and eating disorders.

The current study follows up on findings suggesting that children and adolescents in Italy were resilient throughout the pandemic, keeping up with healthy habits and managing diabetes appropriately in lockdown. Initial data suggested that children and adolescents with diabetes did not experience any more eating issues in lockdown compared with age-matched controls.

The original study included 138 patients with T1D and 276 healthy children and adolescents, 85 and 176 of whom, respectively, agreed to re-enroll in the follow-up 8 months after the initial analysis. Researchers aimed to compare disordered eating behavior (DEB) symptom prevalence in each group during and after the COVID-19 lockdowns.

All T1D patients were aged between 8 and 19 years and did not have any additional significant developmental, cognitive, psychological, or medical conditions. Diagnosis with T1D at least 1 year before enrollment and continuous glycemic monitoring device for a minimum of 6 months prior to the study were also inclusion criteria. The Children Eating Attitudes Test (ChEAT) questionnaire was used to assess DEB symptoms in patients aged 8-13 years, and the Eating Attitudes Test-26 (EAT-26) was used for participants older than 13 years. Both surveys include 26 questions assessing 3 categories:

• Dieting, which encompasses weight and calorie concerns, food avoidance, and a preoccupation with thinness
• Bulimia and Food Preoccupation, including thoughts or preoccupation with food and binging and purging tendencies
• Oral Control, or self-control regarding eating and the perceived social pressure to gain weight

Hemoglobin A1C (HbA1c) and zBMI values were also analyzed to gauge changes to glucose values and body mass changes, respectively.

At follow-up, patients in the T1D cohort did not show any changes in Hb1Ac or zBMI, and all of the overall ChEAT/EAT-26 scores remained stable from baseline to follow-up. Oral Control scores improved significantly in the T1D cohort over the course of the study, particularly in patients younger than 13 years old. However, older participants’ Oral Control scores were unchanged between initial analysis and follow-up. Female respondents tended to score significantly higher than males in the Dieting and Bulimia subcategories of the ChEAT/EAT-26 surveys, but no Hb1Ac or zBMI differences were seen.

There were no significant differences between the zBMI or most ChEAT/EAT-26 scores in the T1D cohort versus the control cohort. Dieting scores were higher in T1D patients, and participants with T1D who were older than 13 years showed higher Dieting scores and lower Oral Control scores than participants in the control cohort.

The study was limited by the collection of data via online questionnaires, a lack of contextual information regarding potential confounding factors, and self-reporting of objective health measures. The small sample size and since-center nature of the study may also limit generalizability.

Even so, the findings suggest children and young adults with and without T1D adapted to conditions in COVID-19 lockdown and did not experience adverse effects pertaining to eating behaviors. This highlights the importance of maintaining adequate and flexible diabetes care, especially during times when psychological stressors make such management challenging.

Reference

Troncone A, Chianese A, Cascella C, et al. Eating problems in youths with type 1 diabetes during and after lockdown in Italy: An 8-month follow-up study. J Clin Psychol Med Settings. Published online May 30, 2022. doi:10.1007/s10880-022-09884-7