Associations of Diabetes-Related Distress, Disordered-Eating Risk, and Self-Perceived Health with Glycemic Outcomes in Adolescents with Type 1 Diabetes: An Exploratory Cross-Sectional Study

Abstract

Background/Objectives: Adolescents with type 1 diabetes mellitus (T1DM) are particularly vulnerable to psychological distress, disordered-eating (DE) risk and negative self-perceived health status (SPHS), which may compromise metabolic control and self-care. Although these factors have been studied individually, the usefulness of brief and clinically feasible screening tools to detect these dimensions remains underexplored. This study aimed to: (1) examine associations between distress, DE risk and SPHS; (2) explore their relationships with glycemic control, clinical profile and self-care; and (3) assess the influence of age and diabetes duration on these outcomes. Methods: A cross-sectional study was conducted in 37 adolescents with T1DM in Spain. Sociodemographic, anthropometric and clinical variables were obtained from medical records. Distress, DE risk and self-care were assessed using validated questionnaires, while SPHS was measured using single-item question. Pearson and Spearman correlations were performed. Results: Distress was present in 48.6% of participants and DE risk in 29.7%, while 67.6% reported positive SPHS. Distress correlated with higher HbA1c and lower TIR. DE risk correlated with BMI. Lower SPHS was associated with higher HbA1c. Age and diabetes duration were associated with greater glycemic variability, and diabetes duration also correlated with higher glucose and TyG-based insulin resistance indexes. No significant associations were found for self-care behaviors. Conclusions: Distress, DE risk and SPHS, assessed through feasible screening tools, showed meaningful associations with metabolic outcomes in adolescents with T1DM. Integrating brief psychological screening tools into routine care may facilitate early identification of psychological vulnerability profiles in this population during routine practice.