Background: Individuals with type 1 diabetes (T1D) are at increased risk of developing disordered eating (DE) and eating disorders (ED). Diabetes self-management focuses on food and insulin administration, which may contribute to development of EDs. The dual diagnosis may contribute to suboptimal glycemia, early diabetes-related complications and mortality. Evidence for ED prevention programs for this high-risk population remains limited. This systematic review aims to evaluate the feasibility and efficacy of available interventions to prevent EDs and improve glycemia in people with T1D.
Methods: A literature search of PubMed, Embase, PsycINFO, CINAHL and Web of Science was conducted on 25 January 2025. Studies using randomized controlled, quasi-experimental or cohort design that targeted ED prevention in T1D population were included.
Results: Nine studies met the inclusion criteria, featuring interventions such as cognitive dissonance based programs, psychoeducation and self-compassion programs. Cognitive dissonance based programs demonstrated the most consistent reduction in ED risks and symptoms. However, most studies showed negligible improvement in glycemia. Common limitations were small sample sizes, high drop-out rates and short follow-ups.
Conclusion: Future research should focus on well-powered RCTs to evaluate interventions over longer timeframes, younger age groups, both genders, carer involvement and additional modifications to improve glycemia concurrently.
Keywords: Disordered eating; Eating disorder; Intervention; Systematic review; Type 1 diabetes.
People with type 1 diabetes (T1D) must pay continual attention to food consumption and insulin administration daily to self-manage their blood sugar levels. This constant focus on food can increase the risk of developing disordered eating behaviors/thoughts and eating disorders. When individuals are diagnosed with both T1D and an eating disorder, blood sugar levels are unstable, resulting in a much higher risk of early diabetes complications, hospitalization and shortened lifespan.We reviewed studies that tested programs to prevent eating disorders in individuals with T1D. We found nine studies that included different types of programs, such as group discussions that challenge negative body image (cognitive dissonance based programs), psychology-based educational sessions, resilience and self-compassion workshops. Programs using cognitive dissonance approaches showed the most benefit in lowering eating disorder risk. However, none of the studies showed significant improvement in blood sugar levels.Overall, research in this area is still limited. Many studies were small and short-term. More long-term, larger studies are needed to understand what works best, especially for younger individuals and across genders. Involving families and adjusting the programs to also support blood sugar management could help future programs be more effective.
© 2025. Crown.