Concurrent validity of self-report measures of eating disorders in adolescents with type 1 diabetes

Abstract

Aim: Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. Methods: In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. Results: The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency; Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. Conclusion: Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines individual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention. INTRODUCTION There has been long standing interest in the association of eating disorders and young women with type 1 diabetes (1,2). Meta-analysis shows the prevalence of Bulimia Nervosa in female adolescents with type 1 diabetes is approximately twice that of their peers (1,2) as is Eating Disorder Not Otherwise Specified and subthreshold eating disorders (1). The prevalence of Anorexia Nervosa, however, is not greater than controls (1,2). Recent studies also indicate that males with type 1 diabetes may be at increased risk for developing eating disorders (3-5). In adolescents with type 1 diabetes, these clinical and subthreshold eating disorders are often associated with insulin manipulation for the purpose of weight control (1,6). Negative physical and psychological outcomes (7) have been documented when clinical eating disorders and milder forms of eating disorders are combined with type 1 diabetes, including an increased risk of ketoacidosis (8) and early onset of microvascular complications, particularly retinopathy (9,10). Early detection of disordered eating.