Carbohydrate counting and risk of disordered eating in young people with type 1 diabetes

Young people living with type 1 diabetes have a higher risk of developing disordered eating when compared to their peers living without the condition. Disordered eating is difficult to manage in someone with type 1 diabetes because it must be treated in specialist units that treat both the eating behaviour and any complications associated with diabetes.

The UK doesn’t currently offer specialised services for children and young people affected by disordered eating while living with diabetes. Understanding and preventing disordered eating among this patient group should be a priority.

A person living with type 1 diabetes usually manages their condition by calculating the carbohydrate content of a meal and adjusting their insulin dose accordingly. This is called carbohydrate counting. Carbohydrate counting is complex, and fixating on the nutritional value of food may contribute to disordered eating.

Our understanding of eating and food choice comes from researching the psychological aspects of eating behaviour, such as:

• portion size
• food reward
• memory for recent eating
• restraint

Applying this research to young people with type 1 diabetes may improve our understanding of the potential positive and negative impact of carbohydrate counting.

Project aims

We would like to understand how best to identify young people at risk of developing negative behaviours around food and eating, before they start carbohydrate counting for themselves. Carbohydrate counting often starts in adolescence, when the risk for developing eating disorders is also at its highest. We hope that intervening at this stage would prevent young people from developing disordered eating.

We want to:

• understand barriers affecting eating behaviours and adherence to carbohydrate counting
• find ways of understanding and assessing adherence to and adaption of carbohydrate counting
• explore reasons why people might restrict/omit insulin doses or restrict/binge on food
• define risks for developing disordered eating when living with type 1 diabetes

What we hope to achieve

We hope to increase our understanding of the relationships between carbohydrate counting, the psychological aspects of eating behaviour and the risk of disordered eating.

This research will pave the way to developing a new tool for assessing the risk of developing an eating disorder while living with type 1 diabetes. We will then use this new tool to develop a behaviour change intervention aimed at preventing negative beliefs/attitudes and associations that can start before a clinical eating disorder develops.

This research is part of a PhD project. It is being led by Karen Rigby with supervision from Dr Elanor Hinton, Professor Julian Hamilton-Shield, Dr Toby Candler and Dr Rosie Anderson.