Disordered Eating Behaviors and Psychological Distress in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study from Tunisia
Abstract
Background: Disordered eating behaviors (DEBs) and psychological distress may complicate type 2 diabetes mellitus (T2DM) care. Objective: To estimate the frequency of DEB screening positivity and examine associated characteristics in a Tunisian T2DM clinic sample. Methods: This cross-sectional study included 400 adults assessed between January and April 2023 using the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire; Bulimic Investigatory Test Edinburgh (BITE); four-item Perceived Stress Scale (PSS-4); and Hospital Anxiety and Depression Scale (HADS). Exploratory analysis estimated crude prevalence ratios (PRs). Adjusted odds ratios (aORs) came from a logistic model including age, sex, body mass index (BMI), diabetes duration, and PSS-4. Separate secondary models replaced PSS-4 with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) or depression subscale (HADS-D). Results: DEB positivity was 26.8% (107/400; 95% confidence interval [CI], 22.6–31.3%). Crude DEB prevalence was higher in women than men (30.4% versus 19.2%; PR, 1.58; 95% CI, 1.06–2.35), in participants with HADS-A ≥11 versus <11 (PR, 2.28; 95% CI, 1.64–3.17), and with HADS-D ≥11 versus <11 (PR, 1.49; 95% CI, 1.08–2.05). In the primary adjusted model, DEB positivity was associated with younger age (aOR per year, 0.952; 95% CI, 0.922–0.982), higher BMI (aOR per kg/m2, 1.083; 95% CI, 1.042–1.126), and higher PSS-4 (aOR per point, 1.133; 95% CI, 1.067–1.203). HADS scores were positively associated in separate adjusted models. Glycated hemoglobin (HbA1c) was high in both groups (10.36% versus 9.91%; difference, 0.45 percentage points; 95% CI, −0.01 to 0.92). Conclusions: Approximately one-quarter of this clinic sample had a positive DEB screen. Associations with psychological symptoms support attention to eating concerns and emotional well-being in diabetes care. However, cross-sectional data limit causal interpretation, and future longitudinal studies are warranted.