{
  "abstract": "Objective To address whether eating disorders (ED) or insulin omission (IOM) in adult persons living with type 1 diabetes (pwT1D) are associated with impaired glycaemic control.Design Cross-sectional analysis.Settings The French-Speaking Diabetes Society—Type 1 Diabetes Cohort (SFDT1) is an ongoing epidemiological cohort study that includes pwT1D in France who attend hospitals or private ambulatory diabetes centres.Participants Adult participants from the SFDT1 study, with data on ED and IOM. The current analysis was performed on data collected during the baseline visit in participants enrolled between December 2020 and March 2024.Main outcome measures Using the SCOFF, a self-reported questionnaire to screen for ED, and a single question on IOM to screen for IOM, we described four categories of pwT1D: no ED & no IOM, ED & no IOM, no ED & IOM and ED & IOM. We performed unadjusted and adjusted (for age, sex, diabetes duration, social vulnerability, smoking, alcohol status and insulin treatment) multinomial logistic regression models with the four categories as the outcome and glycaemic variables as explanatory variables, including continuous glucose monitoring (CGM) variables and HbA1c. No ED & no IOM was the reference outcome for all comparisons. We stratified each model by sex and fear of hypoglycaemia.Results We included 1113 participants, 51% males, median (IQR) age 38 (29–50) years, diabetes duration 21 (12–32) years. Prevalences were as follows: no ED & no IOM: 68% (n=758), ED & no IOM: 11% (n=124), no ED & IOM: 16% (n=177) and ED & IOM: 5% (n=54). With the fully adjusted model, and compared with the group no ED & no IOM, time in range (OR (95% CI) 0.5 (0.4 to 0.7)) and time below range (0.5 (0.3 to 0.8)) were inversely associated with ED & IOM. Moreover, time in range (0.4 (0.4 to 0.5)) was associated with IOM & no ED. Time above range (2.2 (1.6 to 2.9)), Glycaemic Risk Index (1.8 (1.3 to 2.5)), glucose monitoring indicator (2.2 (1.7 to 2.9)) and HbA1c (2.0 (1.5 to 2.5)) were directly associated with ED & IOM. We did not observe associations between CGM variables and ED & no IOM. Most associations were valid in both men and women. The associations were stronger in participants with a fear of hypoglycaemia. However, the associations remained even in people with a fear of hypoglycaemia.Conclusions Both ED and IOM are frequent in pwT1D, and IOM seems to be associated with impaired glycaemic control. As our analysis was cross-sectional, we cannot infer causality and cannot know whether IOM was a result of glycaemic control or the inverse (reverse causality). Our results suggest that IOM should be systematically screened in clinical practice. Further research is needed to better identify and care for EDs, with or without IOM, in T1D.Trial registration number NCT04657783.",
  "authors": [
    {
      "affiliations": [
        "Department of Endocrinology, Diabetes and Nutrition, University Hospital of Toulouse, Toulouse, France",
        "UMR1295 CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations, Inserm, Toulouse, France"
      ],
      "name": "Patrick-Jean Ritz"
    },
    {
      "affiliations": [
        "Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg"
      ],
      "name": "Gloria A Aguayo"
    },
    {
      "affiliations": [
        "University Sorbonne Paris Cité, Bobigny, France",
        "Department of Endocrinology‑Diabetology‑Nutrition, Avicenne Hospital, APHP, Paris, France"
      ],
      "name": "Emmanuel Cosson"
    },
    {
      "affiliations": [
        "Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg"
      ],
      "name": "Dulce Canha"
    },
    {
      "affiliations": [
        "University Hospital of Montpellier, Montpellier, France"
      ],
      "name": "E Renard"
    },
    {
      "affiliations": [
        "Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Rhonda M Merwin"
    },
    {
      "affiliations": [
        "Nutrition and Obesities",
        "Systemic Approaches (NutriOmics), Sorbonne Université, INSERM UMRS, Paris, France"
      ],
      "name": "Chloe Amouyal"
    },
    {
      "affiliations": [
        "Département d’Endocrinologie, Centre Hospitalier Bretagne Atlantique, Vannes, France"
      ],
      "name": "Gwenaelle Arnault"
    },
    {
      "affiliations": [
        "Hospital Centre Compiegne-Noyon Noyon Site, Noyon, France"
      ],
      "name": "Kalliopi Bilariki"
    },
    {
      "affiliations": [
        "Franche-Comte Hospital, Besançon, France"
      ],
      "name": "Sophie Borot"
    },
    {
      "affiliations": [
        "University Hospital Centre Nice, Nice, France"
      ],
      "name": "Nicolas Chevalier"
    },
    {
      "affiliations": [
        "Centre Hospitalier Universitaire de Lyon, Lyon, France"
      ],
      "name": "Amal Lemoine"
    },
    {
      "affiliations": [
        "South Francilien Hospital Centre Gilles de Corbeil Site, Corbeil-Essonnes, France"
      ],
      "name": "Sylvia Franc"
    },
    {
      "affiliations": [
        "Centre Hospitalier Agen-Nérac, Agen, France"
      ],
      "name": "Bénédicte Frémy"
    },
    {
      "affiliations": [
        "Département d'Endocrinologie, Diabétologie et Maladies Métaboliques, Hôpital Saint Louis, La Rochelle, France"
      ],
      "name": "Didier Gouet"
    },
    {
      "affiliations": [
        "Hopital Lariboisiere, Paris, France"
      ],
      "name": "Jean-Baptiste Julla"
    },
    {
      "affiliations": [
        "Diabetology, University Hospital Centre Lyon, Lyon, France"
      ],
      "name": "Lucien Marchand"
    },
    {
      "affiliations": [
        "Jean-Verdier University Hospital, Bondy, France"
      ],
      "name": "Sara Pinto"
    },
    {
      "affiliations": [
        "University Hospital Centre Bordeaux, Talence, France"
      ],
      "name": "Vincent Rigalleau"
    },
    {
      "affiliations": [
        "Brest University, Brest, France"
      ],
      "name": "Emmanuel Sonnet"
    },
    {
      "affiliations": [
        "AP-HP, Paris, France"
      ],
      "name": "Sopio Tatulashvili"
    },
    {
      "affiliations": [
        "Hôpital Gabriel Montpied, Clermont-Ferrand, France"
      ],
      "name": "Igor Tauveron"
    },
    {
      "affiliations": [
        "Department of Diabetology and Endocrinology, Assistance Publique, Hôpitaux de Paris, Paris, France",
        "Department of Diabetology and Endocrinology, Université de Paris, Paris, France"
      ],
      "name": "Jean-Pierre Riveline"
    },
    {
      "affiliations": [
        "Diabetology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France",
        "Diabetology, Toulouse III University-Paul Sabatier, Toulouse, France"
      ],
      "name": "Hélène Hanaire"
    },
    {
      "affiliations": [
        "Luxembourg Institute of Health, Strassen, Luxembourg"
      ],
      "name": "Guy Fagherazzi"
    }
  ],
  "title": "Association of eating disorders and/or insulin omission with impaired glycaemic control in persons living with type 1 diabetes: cross-sectional analysis of the French SFDT1 study",
  "uid": "b6189789-0990-57a7-93f1-a73822a860f9"
}