Sample characteristics
Out of 305 parents of children with T1D who were approached, 153 were excluded (N=26 could not be reached by phone due to incorrect phone numbers or lack of answers, N=127 patients had not been using the FreeStyle Libre sensor). In addition, N=7 parents were unwilling to participate, due to general worries that their children would undergo psychological evaluation, temporary family problems, or reluctance/difficulty in using mobile phones and web-based information; N=7 children refused to participate, due to lack of interest or because they were completing homework or busy with other activities.
In terms of the healthy control sample, of 310 parents approached, N=5 could not be reached (due to lack of answers), and N=5 parents refused to participate (out of perplexity regarding the possibility of their children undergoing psychological evaluation). N=2 were excluded because a second analysis revealed that they did not meet the inclusion criteria (i.e., they suffered from chronic illnesses). Selections were made from the N=298 healthy participants enrolled in order to achieve the best matching control peers (for age and gender).
In the end, the study samples consisted of 138 children and adolescents with T1D (65 m, 73 f) and 276 healthy peers (112m, 164f). The demographic and clinical information of children with T1D are shown in Table 1.
Table 1. Demographic and clinical data of participants with T1D and controls
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T1D
N=138
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Healthy controls
N= 276
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M (SD)
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M (SD)
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p
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Sample size (N)
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138
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276
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Gender (N) (male/female)
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65/73
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112/164
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.206
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Age (years)
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13.67(3.21) (range 8.01-19.11)
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13.78 (3.01) (8-19.11)
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.725
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Diabetes duration (years)
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5.98 (3.22)
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-
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-
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HbA1c (%) estimation 15-30 days / latest visit
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8.45(1.44) - 8.42(1.33) / 8.24 (1.2)†
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-
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-
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z-BMI (current)/latest visit
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.53 (1.01)/.89(1.03) ‡
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.42 (.96) / -
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.353
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Data are presented as mean values and standard deviations unless otherwise stated.
Abbreviations: T1D= type 1 diabetes; N=number of subjects; z-BMI=standardized body mass index
†Compared with HbA1c as measured in latest visit (estimation 15 days t(137)= -1.723, p=.087; 30 days t(137)= -1.609, p=.110)
‡ Compared with zBMI as measured in latest visit (t (137)=8.102, p<.0001)
No statistically significant differences were found between the children with T1D and the control group in terms of gender (X2= 1.599, p=.206), age (t(412)=-.352, p=.725), or zBMI (t(412)=1.110, p=.267).
In participants with T1D, the current mean zBMI of .53(1.01) was significantly lower than that measured at the latest visit (t (137)=8.102, p<.0001), while mean HbA1c values (15/30 days estimation) of 8.42% (68 mmol/mol) did not differ from those measured at the latest visit (15 days t(137)= -1.723, p=.087; 30 days t(137)= -1.609, p=.110). Factorial ANOVA confirmed that compared to healthy controls, participants with T1D did not differ in zBMI values (F(1,414)=.869, p=.353). Additionally, factorial ANOVA revealed no significant main effect of gender (F(1,414)=496, p=.482) or interaction (gender × disease) (F(1,414)=1.018, p=.313) on zBMI values.
DEBs in DT1 and controls
The mean score for each ChEAT/EAT-26 subscale by group can be seen in Table 2.
Table 2. Ch-EAT/EAT-26 Cronbach’s alpha coefficients, mean scores in total sample, children and adolescents with and without T1D. Frequency of DEBs as measured by Ch-EAT/EAT-26 in total sample, children and adolescents with and without T1D. Comparisons of means and frequencies on the basis of illness and age.
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Total sample
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Children (≤13y)
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Adolescents (>13y)
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T1D
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Controls
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T1D
N=138
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Controls
N= 276
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T1D vs. Ctrl
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T1D
N=51
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Controls
N=107
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T1D vs. Ctrl
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T1D
N=87
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Controls
N=169
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T1D vs. Ctrl
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Children vs. Adolescents
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Children vs. Adolescents
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α
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M (SD)
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M (SD)
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p
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M (SD)
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M(SD)
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p
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M (SD)
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p
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p
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p
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Ch-EAT/EAT-26
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Score ≥ 20 % (N)
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8.69 (12)
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13.4 (37)
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.162
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3.9 (2)
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14.9 (16)
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.056
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11.49 (10)
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12.4 (21)
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.83
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.128
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.827
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Dieting
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.695/.868
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6.38(5.53)
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5.8(6.88)
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.132
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5.20(3.91)
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4.87(5.19)
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.394
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7.07(6.21)
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6.38(7.72)
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.225
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.061
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.093
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Oral control
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.656/ .698
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2.23(2.55)
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2.67(3.59)
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.358
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3.45(2.89)
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3.79(3.93)
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.694
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1.52(2.03)
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1.96 (3.18)
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.413
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<.0001
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<.0001
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Bulimia food preocc.
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.529/.787
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1.14(1.86)
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1.41(2.58)
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.427
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1.14(1.39)
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1.21(1.96)
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.840
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1.14 (2.1)
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1.54 (2.9)
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.410
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.913
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.564
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Total score
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.696/.909
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9.75(7.71)
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9.88(10.79)
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.636
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9.78(5.27)
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9.87(7.59)
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.748
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9.72(8.87)
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9.89(12.41)
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.731
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.916
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.815
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Abbreviations: T1D= type 1 diabetes; Ctrl= control; Bulimia food preocc.= Bulimia and Food Preoccupation
The Cronbach’s alpha reliability coefficient for the EAT-26 and the ChEAT (total scores) showed satisfactory levels (Table 2).
Total sample. According to the ChEAT/EAT-26 scores, 8.69% (N=12) of participants with T1D and 13.4% (N=37) of controls had values of 20 or more, indicating presence of DEBs. No significant differences in DEB frequency were seen between patients and healthy controls (X2=.1956, p=.162), between children (X2=3.66, p=.055) and adolescents with T1D (X2=.134, p=.714) compared to matched healthy peers, between children with T1D and adolescents with T1D (X2=2.322, p=.128), and between children and adolescents of control (X2=.048, p=.827).
Two-way ANOVA (disease × gender) indicated that participants with T1D did not score differently from healthy controls in any ChEAT/EAT-26 scales (Dieting F(1,414)=2.282, p=.132; Oral control F(1,414)= .848, p=.358; Bulimia and Food Preoccupation F(1,414)=.631, p=.427; Total score F(1,414)= .224, p=.636).
There were main effects of gender for all of the ChEAT/EAT-26 subscales (Dieting F(1,414)= 27.207, p=.000, η2 = .062; Oral Control F(1,414)=3.987, p=.047, η2 = .010; Bulimia and Food Preoccupation F(1,414)=11.002, p=.001, η2 =.026; Total score F(1,414)=24.118, p<.0001, η2 = .056), indicating that girls had significantly higher ChEAT/EAT-26 scores than boys.
There was also an interaction between disease and gender for two ChEAT/EAT-26 subscales and the Total score (Dieting F(1,414)= 4.954, p=.027, η2 = .012; Oral Control F(1,414)=3.963, p=.047, η2 =.010; Total score F(1,414)=5.621, p=.018, η2 =.014), with healthy boys having lower EAT scores than other groups. No interaction effects were found for Bulimia scores (F(1,414)=.888, p=.347).
Children. In a comparison of children (≤13y) with T1D to matched healthy controls, no significant differences were found in the ChEAT Total score (F(1, 157)=.104, p=.748) or in subscale scores (Dieting F(1,157)=.732, p=.394; Oral Control F(1, 157)=.155, p=.694; Bulimia and Food Preoccupation F(1,157)=.041, p=.840).
A main effect of gender was found for the ChEAT Total score (F(1, 157)= 5.811, p=.017, η2 =.036) and the Dieting (F(1,157)=6.532, p=.012, η2 =.041) subscale—with girls having higher scores than boys—but not for Oral control (F(1,157)=1.902, p=.170) or Bulimia and Food Preoccupation (F(1,157)= .125, p=.725), for which the scores did not differ between boys and girls.
There was an interaction effect of disease × gender only for Dieting scores (F(1,414)=4.356, p=.039, η2 =.028), indicating that healthy boys had the lowest ChEAT scores compared to other groups. No interaction effects were found for Oral Control (F(1,157)=.263, p=.609), Bulimia and Food Preoccupation (F(1,157)= .111, p=.740), and Total score (F(1,157)=3.259, p=.073).
Adolescents. In a comparison of adolescents (>13y) with matched healthy controls, no significant differences were found in the EAT-26 Total score (F(1, 255)=.135, p=.731) or in its subscales (Dieting F(1,255)=1.418, p=.225; Oral Control F(1, 255)=.674, p=.413; Bulimia and Food Preoccupation F(1,255)=.680, p=.410).
For all comparisons, ANOVA indicated a significant main effect of gender on the EAT-26 Total score and subscale scores (Total score F(1,255)=18.421, p<.0001, η2 = .068; Dieting F(1, 255)=21.157, p=.000, η2 =.077; Bulimia and Food preoccupation F(1,255)=16.360, p<.0001, η2 =.061) except for the Oral Control subscale (F(1,255)=2.382, p=.124).
Interaction effects of disease × gender were only found for the Oral Control subscale (F(1,255)=5.703, p=.018, η2 =.022), indicating that healthy girls had the highest EAT-26 scores compared to other groups. No significant interaction (gender × disease) effects were found for Total score (F(1, 255)= 3.203, p=.075), Dieting F(1,255)=2.180, p=.141), or Bulimia and Food Preoccupation (F(1, 255)=.939, p=.333) scores.
Children vs. adolescents. In a comparison of children with T1D and adolescents with T1D, no significant differences were found in the ChEAT Total score (F(1,138)=.011, p=.916) or for two subscales (Dieting F(1,138)=3.569, p=.061; Bulimia and Food Preoccupation F(1,138)=.012, p=.913). A main effect of age was found for the Oral Control subscale (F(1,138)= 20.411, p<.0001, η2 =.132), indicating that adolescents had lower scores than children.
No main effect of gender and no interaction effects (gender × age) were found for the ChEAT/EAT-26 Total score (gender F(1, 137)= 2.497, p= .116; interaction F(1,137)=1.139, p=.288) or for Dieting (gender F(1,137)=2.854, p=.093; interaction F(1,137)=1.693, p=.195), Oral control (gender F(1,138)=.070, p=.792; interaction F(1,138)=1.013, p=.316), or Bulimia and Food Preoccupation (gender F(1,138)=1.651, p=.201, interaction F(1,138)=3.774, p=.054) scores.
In a comparison of healthy children with adolescents, no significant differences were found in the ChEAT/EAT-26 Total score (F(1, 276)=.055, p=.815) or in two subscales (Dieting F(1,276)=2.845, p=.093; Bulimia and Food Preoccupation (F(1,276)=.334, p=.564). A main effect of age was found in the Oral Control subscale score (F(1, 276)=18.271, p<.0001, η2 =.063), indicating that adolescents had lower scores than children.
A main effect of gender was found for Total score (F(1, 276)=17.825, p<.000, η2 =.093), Dieting (F(1,276)=32.362, p<.0001, η2 =.106), Oral Control (F(1,276)=9.254, p=.003, η2 =.033), and Bulimia and Food Preoccupation (F(1,276)=7.263, p=.007, η2 =.026), indicating that girls had higher scores than boys.
No interaction effects were found for the ChEAT/EAT-26 Total score (F(1,276)=2.277, p=.132), Dieting (F(1,276)=1.345, p=.247), or Oral Control (F(1,276)=.109, p=.741). An age × gender interaction was only found in Bulimia and Food Preoccupation (F(1,276)=7.370, p=.007, η2 =.026), indicating that adolescent girls had the highest scores of all groups.
Predictors of DEBs
Table 3 presents the results of a hierarchical regression predicting DEBs (ChEAT/EAT-26 scores) in participants with T1D and in healthy controls.