641-P: Body Image and Insulin Restriction among Adolescents with Type 1 Diabetes

Introduction: Adolescents with type 1 diabetes (T1D) are at increased risk for disordered eating compared to peers without T1D. We examined whether a single item assessing preference for thinness vs. glycemic control was associated with T1D health outcomes (HbA1c and DKA) among adolescents with T1D. Methods: 224 adolescents (M age=16.9±1.1, 49% female, M HbA1c=8.5%±1.3) were recruited through the T1D Exchange to complete an online survey, including one item from the Diabetes Eating Problems Survey-R, “I would rather be thin than have good control of my diabetes”, which included a 6-point Likert scale (never to always), and one item from the Diabetes-Specific Risk-Taking Inventory, “Taken less insulin than you knew you needed”, which included a 6-point Likert scale (never to daily). Adolescents also reported whether they experienced DKA in the past year. We obtained HbA1c values from the T1D Exchange Registry database. Results: Greater priority for thinness was correlated with higher HbA1c (r=0.17, p=0.01). Adolescents who experienced DKA in the past year also reported higher priority for thinness over glycemic levels (M=1.80, SD=1.86) than those who had not experienced DKA (M=0.88, SD=1.35; t(164)=2.43, p < 0.05). Adolescents who reported experiencing DKA in the last year did not differ in how frequently they restricted insulin (M=2.33, SD=1.59) compared to adolescents who had not experienced DKA (M=2.37, SD=1.51; t(163)=0.12, p > .05). Conclusions: Prioritizing thinness over glycemic health may increase risk for higher HbA1c and DKA; and may be more closely associated with DKA events than restricting insulin. This finding aligns with existing evidence that body image concerns are predictive of diabetes outcomes, and recommendations in ADA guidelines to screen for body image concerns. This single item (prioritizing thinness) may be a useful question for such screening. Future research should examine how body image concerns are linked with disordered eating behaviors and T1D outcomes.