P-189: Perceptions of disordered eating screening questions by adolescents with type 1 diabetes
J Warnick, K E Darling, L S Topor, A B Goldschmidt, R Merwin, A Goebel-Fabbri, D Olbrych, E Smrstik, M Watts, J Baldani, K Pham, E JelalianAbstract
Introduction
Adolescents with type 1 diabetes (T1D) face significant risk for disordered eating, with up to 43% endorsing symptoms. The Diabetes Eating Problems Survey – Revised (DEPS-R) is a foundational tool for screening; however, the T1D management landscape has shifted towards the use of more advanced technologies (i.e., CGMs, pumps, AID systems) since its validation. Additionally, this measure was initially developed for adults, and some pediatric providers have expressed concerns about the potential for iatrogenic effects of screening in a vulnerable developmental population.
Objectives
The study used cognitive interviewing to evaluate 1) adolescents’ interpretation of the DEPS-R items to determine if a revision was merited; and 2) whether screening prompted intention to engage in new disordered eating behaviors.
Methods
Adolescents with T1D (13-17 years old; n=51) completed the DEPS-R followed by a cognitive interview. Using an iterative approach, data were reviewed every ∼10 participants to refine phrasing, face validity, and clinical specificity as needed.
Results
Initial cognitive interviews and two refinement phases revealed that the original DEPS-R did not sufficiently distinguish between T1D management and disordered eating among adolescents. A multidisciplinary panel of professionals (i.e., endocrinology, psychology, and dietetics) developed a new measure by adapting evidence-based measures, creating new items, and integrating adolescents’ feedback to enhance specificity. Two final rounds of cognitive interviewing yielded a revised screening tool for disordered eating behaviors in adolescents with T1D. Of note, no participants reported intention to change their behaviors in response to completing the measures.
Conclusions
Building on the DEPS-R, this study developed a refined screening tool for adolescents with T1D with potentially improved safety and relevance, considering changes in the T1D standards of care. The newly developed measure requires validation in relevant clinical samples.