LAS VEGAS — Adolescent girls with type 1 diabetes are twice as likely to have a disordered eating behavior than their non-diabetic counterparts and have the unique ability to omit insulin as a weight reduction strategy, but little research has focused on strategies to reduce these behaviors in this population.

“Maladaptive eating behaviors like this don’t occur at a frequency high enough to meet criteria for a formal eating disorder and at-risk girls are difficult to identify with existing screening tools,” Terri L. Schmitt, PhD, ARNP, FNP-BC, CDE, an assistant professor at the West Palm Beach, Florida campus of the Chamberlain College of Nursing said during a poster session at the National Association of Pediatric Nurse Practitioners 2015 meeting.

But insulin omission in this population has serious health implications, including greater rates of and more rapid onset of retinopathy, neuropathy and nephropathy and increased risk of diabetic ketoacidosis.

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So Schmitt developed and tested the feasibility and acceptability of the Beautiful YOU Team Intervention (BEYOUTI) to address the three major risk factors for disordered eating behaviors in this population: low self-esteem, and poor body image and mother-daughter communication.

The intervention consisted of a single, two-hour session focused on mother-daughter communication and addressed deciphering media messages, body and self-esteem building, and achieving more open communication.

Ten mother-daughter pairs participated in the intervention, which consisted of interactive, educational, skill building, and mother-daughter activities in a local healthcare setting. No more than four mother-pairs were conducted at a single session.

Participants were screened at baseline, immediately after the intervention, and at six-weeks post-intervention to assess variables including eating attitudes (Eating Attitudes Test-26), self-esteem (Rosenberg Self-Esteem Scale), body image (Body Esteem Scale), depression (Major Depression Inventory), maternal relationship (The Inventory of Parent and Peer Attachment), self-reported insulin omission behavior and feasibility/accepatability (open-ended questions).

Seventy percent of participants responded favorable regarding BEYOUTI content, and 95% of participants had set a positive goal, Schmitt found. Participants also showed increases on the BES weight and appearance subscales post intervention.

In terms of missed insulin, 67% reported a missed dose six-weeks post intervention compared with 70% prior to the intervention. None reported missing the dose intentionally, Schmitt reported.

“It was well received. Mothers and daughters both liked it, they liked the sharing and communication aspect and we really saw a lot of improvement on the Body Esteem Scales,” Schmitt said. “The feedback we got from mothers is that we need to be educating them about this issue earlier, because the girls get bombarded with media messages young.”

Next, Schmitt hopes to take the intervention out to American Diabetes Association meetings and Juvenile Diabetes Research Foundation (JDRF) meetings in the community where there is already captive audience of mothers and daughters.

“Practitioners need to be savvy and especially in endocrinology we need to be educating in the office starting young and letting these families know that this happens,” Schmitt said.


  1. Schmitt T. #TH21. “Feasibility and acceptability of a mother-daughter intervention to address disordered eating behavior among adolescent girls living with type 1 diabetes mellitus.” Presented at: NAPNAP 2015. March 11-14, 2015; Las Vegas.