Endocrine Abstracts

Background: Eating disorders (ED) are more prevalent in young people with Type 1 diabetes than their peers and the combination is associated with higher levels of mortality. However, ED are often under-identified in paediatric diabetes services. Using quality improvement methodology, a screening pathway for ED was developed.

Methods: Questionnaires and semi-structured interviews explored participants’ views regarding a screening pathway and choice of screening tool. Three validated screening questionnaires were selected for review: DEPS-R, SEEDS and mSCOFF. 108 patients aged 12-18y and their families were invited to participate. 21 healthcare professionals including doctors, nurses, dieticians, psychologists, eating disorders specialists and school staff were also invited to take part. External organisations supporting young people with diabetes or ED were approached as well.

Results: 17 young people (12-17y, 62.5% female, 37.5% male), 16 parent/carers and six professionals took part. The paediatric diabetes team were enthusiastic about instituting a formal screening process for ED. Barriers to effective screening were identified as: a lack of training in ED, time constraints, lack of specific guidance/resources and the sensitive/secretive nature of ED. Strengths identified included MDT cohesiveness, good continuity and strong relationships with patients and families. Both young people and professionals preferred the DEPS-R tool, citing its clearer, more specific questions; parent/carers preferred the SEEDS saying it was less invasive. mSCOFF was the least preferred by all groups. Annual review was identified as the best time to incorporate screening, one-to-one away from parents/carers, by a staff member chosen by the young person. Formal training in ED and identifying an ED champion in the diabetes team, joint clinical meetings and shadowing opportunities were also suggested. Teaching sessions on eating disorders in Type 1 diabetes were then delivered to the Paediatric Diabetes team and to the ED team about Type 1 diabetes.

Conclusions and Recommendations: There is a clear need to screen for eating disorders amongst young people with Type 1 diabetes, and to equip staff with knowledge and skills to identify patients at risk. Our service has introduced a formal pathway as part of the annual review process, given specific training to the paediatric diabetes team, and formed a closer partnership with ED services.