Reliability and validity of the Diabetes Eating Problem Survey in Greek adults with type 1 diabetes mellitus

Ιn the management of type 1 diabetes mellitus (T1DM), dietary therapy and the maintenance of a healthyΙn the management of type 1 diabetes mellitus (T1DM), dietary therapy and the maintenance of a healthy body weight (in conjunction with insulin therapy) are significantly associated with good glycemic control and complication reduction. However, a diabetic patient's increased focus on diet and weight control,although necessary, can lead to disturbed eating habits, medical complications, and "resistance" to treatment. The term "diabulimia" refers to the eating disorder in which patients with T1DM take less insulinin order to control their weight. Currently there is no valid questionnaire in the Greek language for the detection of eating disorders in T1DM. This study examines the psychometric properties of the Greek version of the Diabetes Eating Problem Survey-Revised (DEPS-R), a questionnaire that assesses the risk of "diabulimia"in patients with T1DM. 100 outpatients with a T1DM diagnosis of over one year -71 women and 35users of a continuous insulin infusion pump- were asked to complete the DEPS-R questionnaire translated into Greek (0-80 score range, >20 indicating high risk of disorders) along with the EAT-26 (0-78 score range,>20 indicating high risk of pathological eating behaviours or eating disorder) and the Beck Depression Inventory (BDI-ΙΙ) (0-63 score range, >14 indicating high risk of major depressive disorder). The Greek versionof the DEPS-R showed strong internal consistency and construct validity (Cronbach's alpha=0,89 in total,0,90 in females and 0,85 in males). Factorial analysis revealed 4 factors (diet, weight loss, insulin use and compensatory behaviors) accounting for 65.68% of the total variance (19.90%, 18.50%, 15.64% and 11.65%of the total variance respectively). In addition, 35% of the sample scored above 20 on the EAT-26, 26% rated above 14 on the BDI-II and 40% had a score above 20 on the DEPS-R, while the average score was 19.22. The sound psychometric properties of the DEPS-R scale were confirmed for a Greek sample with T1DM suggesting that it could be used as a reliable tool for the detection of diabulimia. In addition, we found that Greek patients with T1DM appear to have an increased risk of developing eating disorders and depression.