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Eighty-five youths with T1D and 176 controls aged 8–19 years were asked to complete online questionnaires (ChEAT and EAT-26) measuring disordered eating behaviors (DEBs) during (baseline) and after (8-month follow-up) the lockdown. DEB symptoms in all participants (especially younger than 13 years), glycemic control, and zBMI were found unchanged from baseline to follow-up (all p > .05). After 8 months, the ChEAT/EAT-26 critical score frequency decreased significantly in controls (p = .004), as was the score for the ChEAT/EAT-26’s Oral Control subscale in both groups (T1D: p = .005; controls: p = .01). Participants with T1D, especially those older than 13 years, had higher ChEAT/EAT-26 Dieting scores (p = .037) and lower ChEAT/EAT-26 Oral Control scores (p = .046) than controls. Unchanged DEB symptoms suggest that the COVID-19 restrictions did not significantly affect participants’ eating behaviors and that a general adaptation to the challenges of lockdown and other pandemic containment measures occurred in both T1D and control participants.

Objective: A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors. Methods: A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included. Results: Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5–60.7%, n = 13 studies), anxiety (7–27.5%, n = 16 studies), and distress (14–86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality. Conclusions: Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.

Despite type 1 diabetes' (T1D) potential influence on adolescents' physical development, the occurrence of body image problems of adolescents with diabetes remains unclear. No research synthesis has yet addressed this issue. This study aims to systematically evaluate the empirical evidence concerning body image in individuals with T1D in order to provide an overview of the existing literature. Using PRISMA methodology, 51 relevant studies that fulfilled the eligibility criteria were found, the majority of them (N = 48) involving youth. The findings varied across studies: 17 studies indicated that in youth with T1D, body dissatisfaction was common and that body concerns were generally greater in youth with T1D than in controls; nine studies did not find any differences in body image problems between participants with and without T1D; three studies described higher body satisfaction in youth with diabetes than in controls; and three studies reported mixed results. Body concerns in individuals with T1D were often found to be associated with negative medical and psychological functioning. The variability and limits in assessment tools across studies, the overrepresentation of female subjects, and the fact that most research in this field is based on cross-sectional data are stressed in the interpretation of these mixed findings. Future research directions that could improve the understanding of body image concerns and clinical implications are discussed.

Background Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed to explore the prevalence of DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls during the COVID-19 lockdown. Methods In a cross-sectional study, 138 children and adolescents with T1D (aged 8.01–19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed an online survey about eating behaviors (ChEAT and EAT-26), anthropometric characteristics, and clinical characteristics. Results 8.69% (N = 12) of participants with T1D and 13.4% (N = 37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients—whether children (total ChEAT score F(1, 157) = .104, p = .748) or adolescents (total EAT-26 score F(1, 255) = .135, p = .731)—and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (p p = .110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138) = 20.411, p 2 = .132, controls: F(1, 276) = 18.271, p 2 = .063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores. Conclusions This exploratory study suggested that children and adolescents with T1D did not experience more DEB symptoms during the COVID-19 lockdown compared to healthy controls. Results revealed DEBs as more of a female adolescent developmental issue rather than a result of the challenges of living with a chronic illness under quarantine measures. Possible effects of parental pressure on their children’s eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed.

Background Given that the widely acknowledged influence of the doctor-patient relationship on objective health parameters and treatment adherence in chronic illnesses, this study sought to explore how patients perceived the patient-doctor relationship across virtual and in-person contexts. Methods Parents’ and patients’ perceptions of doctor-patient relationship were evaluated in 610 children and adolescents (12.17 ± 4.19 years, 50.9% girls) with type 1 diabetes who visited via video-conferencing or in person during the COVID-19 pandemic. Results No differences were found between video consultations and in-person visits in terms of care satisfaction (p > .05), doctor-patient relationship—for the dimensions agreement on tasks (p = .506) and bond (p = .828)—as perceived by parents and physician empathy as perceived by patients (p = .096). Parents rated patient-doctor agreement on explicit goals of treatment higher in video consultation than in person (p = .009, d = .211). Agreement on goals (β = − .180, p = .016) and bond with doctor (β = − .160, p = .034) were negatively and significantly associated with HbA1c values, but only in participants who visited in person. Conclusions Parents’ care satisfaction and perceptions of doctor-patient relationship, along with patients’ perceptions of physician empathy, did not substantially differ between visits carried out in person or via video consultations. Given the high risk of psychological problems described in young people with diabetes, video consultation can be considered a useful opportunity to maintain access to a healthcare provider in a challenging time, such as the COVID-19 pandemic.

The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 +/- 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores >= 20), with higher rates among girls (chi(2) = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.

Objective: The aim of this study was to assess general psychosocial adjustment to diabetes and perceived disease management among patients with type 1 diabetes (T1D) and their parents before and after patients' participation in a diabetes summer camp.Methods: In this follow-up study, 20 children and adolescents with T1D (eight boys; mean age = 11.01 ± 0.94 years; mean diabetes duration = 3.02 ± 2.27) attending a southern Italian diabetic center, along with their parents, were assessed prior to and 3 months after the youths participated in a 1 week camp-based intervention involving didactic and interactive child-centered education and recreational activities. Patients and their parents completed measures assessing patients' quality of life and strategies employed by patients to cope with pain. Patients also completed measures evaluating their diabetes psychosocial adjustment, diabetes self-efficacy management, and illness perception; also, their parents completed measures of caregivers' perceived diabetes burden and treatment satisfaction. Youths' glycated hemoglobin (HbA1c) and standardized body mass index (z-BMI) values were also assessed. Within-subjects repeated-measures analyses of variance evaluated pre- and post-camp changes.Results: Camp attendance showed no beneficial effects on glycemic control, as indicated by HbA1c values both before (7.02%) and after (7.28%) camp being lower than 7.5%. HbA1c values were found to have increased after camp (pre-camp = 7.02%, post-camp = 7.28%; p = 0.010), but since they still fell within an acceptable range, they did not reveal clinically relevant changes in glycemic control. No substantial significant improvement in psychosocial measures was observed in children or parents (all p > 0.05). According to the parents' evaluation, social support-seeking as a patient pain-coping strategy was slightly increased (p = 0.044) after attending the camp.Conclusions: This study does not provide empirical evidence of benefits of participating in a diabetes camp for either patients or their parents. These findings suggest that healthcare providers rethink such camps as an experience for youths with T1D that actively involves parents and that includes both youth- and parent-focused psychological interventions.

Highlights • Covid-19 restrictions disrupted physical activities in children with type 1 diabetes. • Diabetes management worsened in glycemia values and insulin delivery. • Active breaks rather than structured training may interrupt sedentary in children with type 1 diabetes., Aim We explored the physical activity (PA) level and the variation in glycaemic control in children with type 1 diabetes (T1D) before and during the lockdown. Then, we proposed an online training program supported by sport-science specialists. Methods Parents of children with T1D (

To assess the psychometric properties of the Draw a Person: A Quantitative Scoring System (DAP:QSS), in 2543 children (M = 11.43 ± 3.06 years), correlations between drawings scores and Raven’s Matrices scores, age, and academic achievement were examined. Although older children (> 11 years) obtained higher drawing scores than younger ones (p r = 0.493, p r = 0.056, p = 0.097). DAP:QSS scores were significantly associated with Raven’s Matrices score, but low correlation coefficients (0.156–0.498), low sensitivity (0.12), and high false negative (87.9%) and positive (82%) rates suggest poor DAP:QSS validity as an intelligence measure. The researchers concluded that DAP:QSS failed to produce a psychometrically sound assessment of children’s intellectual functioning.

Background: Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed at examining the impact of the COVID-19 lockdown on DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls.Methods: 138 children and adolescents with T1D (aged 8.01-19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed a cross-sectional online survey of eating behaviors (ChEAT and Eat-26), anthropometric characteristics, and clinical characteristics. Results: 8.69% (N=12) of participants with T1D and 13.4% (N=37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients—whether children (total ChEAT score F(1, 157)=.104, p=.748) or adolescents (total EAT-26 score F(1, 255)=.135, p=.731)—and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (pp=.110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138)= 20.411, p2 =.132, controls: F(1, 276)=18.271, p2 =.063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores.Discussion: Psychological conditions in relation to DEB symptoms of children and adolescents with T1D were not aggravated by lockdown conditions. Results indicated DEBs as more of a female adolescent developmental issue rather than as a result of the challenges of living with a chronic illness aggravated by outbreak. Possible effects of parental pressure on their children’s eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed.

ObjectiveTo examine body image problems and their associations with disordered eating behavior in adolescents with type 1 diabetes and well-matched healthy peers.MethodsUsing a cross-sectional design, 183 adolescents with type 1 diabetes (13.02–18.05 years) were recruited from diabetes centers in southern Italy and compared to healthy peers matched for age and gender. Participants completed self-report measures of disordered eating behaviors (DEPS-r and EDI-3RF) and a gender-specific body image problem questionnaire (SATAQ-4R). Socio-demographic and clinical data (zBMI, HbA1c, and disease duration) were also collected. Hierarchical multiple linear regression analyses were computed to determine the relative importance of diabetes variables and body image problems on participants’ disordered eating behaviors after controlling for demographic variables.ResultsAdolescents with type 1 diabetes showed diabetes-specific eating problems in 37.7% of cases and had more eating problem symptoms (assessed as drive for thinness and bulimia) than healthy peers. Male adolescents with type 1 diabetes did not display more body image problems (p > 0.05); females with type 1 diabetes compared to females in the control group were found to be more pressured by family (p = 0.025) but less by media (p = 0.022) to improve their appearance and attain a thin body. zBMI and body image problems contributed to a significant increase in disordered eating behavior risk both in male and female adolescents with diabetes and in healthy peers (zBMI 0.213 < β < 0.426, p < 0.05; body image 0.243 < β < 0.572, p < 0.05). None of the variables analyzed were found to significantly predict male bulimic symptoms (all β < 0.296, p > 0.05).ConclusionSince in adolescence type 1 diabetes and insulin therapy may increase the risk of weight gain and promote focus and attention on the body and thus contribute to the development of body image problems and disordered eating behaviors, continuity of medical, nutritional, and psychological care is needed.

The human figure drawing in children with type 1 diabetes and healthy control individuals: What differences? The purpose of this study was to evaluate the presence of psychological problems in children with type 1 diabetes by using human figure drawings. A total of 81 consecutive patients attending an Southern Italian university pediatric diabetology centre with a diagnosis of type 1 diabetes, along with 219 control subjects matched to the study group for age and gender, were asked to draw human figure drawings according to the Draw a Person: Screening Procedure for Emotional Disturbances (DAP:SPED). The glycosylated hemoglobin (HbA1C) mean value, measured every 3 months over the past year, was used as a measure of metabolic control. No significant differences between the children with type 1 diabetes and controls in the DAP:SPED total scores were observed, even when they were differentiated by gender or by weight An item by item human figure drawings comparison showed that the children with type 1 diabetes drew smaller figures for height and width than the controls, with more frequent presence of pointed fingers and the absence of clothes. Findings indicated the presence of distinctive elements in human figure drawings suggesting the existence of aspects of body image which characterize children with type 1 diabetes and distinguish them from healthy children. The differences observed support the need for monitoring the characteristics of body image in children with type 1 diabetes during the course of the development in order to increase the efficacy of early action to prevent the onset of psychological problems.

Objective To examine changes over a five-year period in body image accuracy and dissatisfaction, as well as relationships with disordered eating behaviors (DEBs), in young patients with type 1 diabetes. Methods Of 81 children (42 male, 39 female) with type 1 diabetes first assessed at ages 5.1–10.06 years, 67 (83%) were re-enrolled and interviewed as adolescents (aged 10.07–15.08 years) at follow-up. DEBs were assessed using a parent-report standardized measure. Height and weight were determined, and BMI was calculated. Glycemic control was assessed by glycated hemoglobin. Results BMI increased from childhood to adolescence. The general tendency towards body size underestimation (i.e., perceiving the body to be smaller than it is) and dissatisfaction, already described at baseline, was found unchanged at follow-up, revealing continuing attitude towards body image problems. Body-size perception accuracy, degree of body-size dissatisfaction, and HbA1c did not increase significantly over five years, but the presence of DEBs was observed. Degree of body dissatisfaction was found to be a significant predictor for DEBs (standardized beta = 0.272, p Conclusion Body image problems persisted over the five-year study period and were found associated with higher levels of DEBs. Identification of such body image characteristics may be useful in developing strategies for intervention early in the course of illness.

This study examined nonverbal intelligence and scholastic achievement in children with type 1 diabetes. In a retrospective case–control study, 69 children (35 males) ages 5–10 years with type 1 diabetes and 69 healthy controls matched to patients by age, gender and socioeconomic status were compared according to their performance on Raven’s Coloured Progressive Matrices and their scholastic grades. No differences in nonverbal intelligence and grades were observed between children with type 1 diabetes and healthy control subjects. Raven’s Coloured Progressive Matrices scores inversely correlated with duration of illness both in children with early onset of type 1 diabetes and poor metabolic control. Possible explanations of the results and implications are discussed.

Background: Age-specific preventive interventions by exploiting age-appropriate means are needed to effectively support adolescents with type 1 diabetes in facing illness and developmental-related difficulties. The provision of social support through a content analysis of messages posted on online conversations was examined. Methods: Participants and moderators' messages posted to an Italian online chat group for adolescents with type 1 diabetes were content analyzed using a social support behavior coding system. Results: Of 250 adolescents approached (aged 12-18), 161 (64.4%) agreed to participate. Seventeen thousand twenty-five individual posts (10 735 written by participants, 6290 by moderators) from 37 chat sessions were examined. Topics concerned management of the disease, diabetes-related problems, nutrition, and the emotional impact of diabetes. Social support was found in 30.64% of the messages (N = 5215). The frequency of supporting messages posted by participants was significantly higher than those written by moderators (X2 = 20.025, P

Objective The purpose of this research is to examine the presence of disordered eating behaviors (DEBs) in youths with type 1 diabetes (T1D) according to their parents' evaluations. The roles of demographic and diabetes-related variables were also analyzed. Methods In 54 patients with T1D (aged 10.07–15.08) and in 54 age- and gender-matched healthy controls, DEBs were assessed using a parent-report standardized measure. BMI was calculated from height and weight. Glycemic control was assessed based on the most recent glycosylated hemoglobin value (HbA1c). The association of demographic and clinical factors with DEBs was evaluated through correlation and linear regression analyses. Results DEBs were observed more frequently in participants with T1D (33.3%) than in controls (11%) (χ2 = 6.501, p = .04). The clinical sample obtained a higher score than controls in PEBEQ total score (t(106) = 2.464, p = .01), as well as in the Exaggerated interest in food (t(106) = 2.723, p = .008) and Rejection/disinterest in food subscales (t(106) = 2.216, p = .01). No gender differences were observed. In participants with T1D, but not in controls, PEBEQ total score was positively correlated with age (r = 0.203, p = .04), HbA1c (r = 0.335, p = .01), and zBMI (r = 0.298, p = .002); HbA1c (standardized beta =0.284, p = .04) was found to uniquely predict the PEBEQ total score. Conclusion Parents' evaluations may contribute to prompt detection of DEBs, which is crucial in developing appropriate strategies for timely intervention, especially during adolescence.

The purpose of this study was to assess messages posted by mothers of children with type 1 diabetes in the Italian Facebook group “Mamme e diabete” using computerized text analysis. The data suggest that these mothers use online discussion boards as a place to seek and provide information to better manage the disease’s daily demands—especially those tasks linked to insulin correction and administration, control of food intake, and bureaucratic duties, as well as to seek and give encouragement and to share experiences regarding diabetes and related impact on their life. The implications of these findings for the management of diabetes are discussed.

Although Facebook groups dedicated to diabetes are widely available on the Internet, little is known about the conversation in them. This study aims to evaluate the content of communication in an Italian Facebook group dedicated to type 1 diabetes “Mamme e diabete”. Messages posted by participants from June to September 2014 were collected and assessed using computerized text analysis. Textual analysis revealed 5 dominant thematic clusters: “food and correction” (33.6 %), “diabetes and life” (18.47 %), “hi group” (16.87 %), “bureaucracy” (15.82 %) and “needle” (15.32 %). Findings suggested that the focus of conversations is on daily management of diabetes and all the topics related. Mothers use online discussion boards also as a place to compare and share experiences regarding diabetes and related impact on their lives and seek and give encouragement by means of the group to better face the burden associated with the illness, its duration and effects on the child and family.

This study evaluated the body image perception in children with type 1 diabetes in order to identify symptoms of disordered eating behaviours early. Children with type 1 diabetes and controls showed underestimation and dissatisfaction with body size. The patients, especially girls, were more accurate in their perception of body size than the control group. The study sheds light on some of the underlying factors that may contribute to the development of disordered eating behaviours in adolescence. The causes of the differences of perception of body size are discussed.