Diabetes management requires close attention to food choices, glucose levels, medication dosing in relation to food intake, and the impact of weight changes. For some individuals, these demands can contribute to or intensify disordered eating behaviors.
Individuals with type 1 diabetes are at increased risk of eating disorders compared to individuals without diabetes 1, and up to 40% of youth with type 1 diabetes are affected by disordered eating behaviors.2
Disordered eating behaviors may include:
- restrictive eating,
- binge eating,
- excessive concern about weight, and/or
- intentionally reducing or omitting insulin to influence weight.
Author: Christine Craig, MS, RDN, CDCES
Founder: Nutrition for Daily Living
Screening Tools for Type 1 Diabetes
For individuals with type 1 diabetes, validated diabetes-specific disordered eating screening measures cited in the ADA Standards of Care include the Diabetes Eating Problem Survey-Revised (DEPS-R) and the modified SCOFF (mSCOFF)1.
The DEPS-R is a 16-item assessment of diabetes-specific eating behaviors, including weight and body-image concerns, restrictive eating, and intentional insulin omission or restriction.4
The mSCOFF is a brief 5-item screening tool adapted from a general eating-disorder questionnaire and also includes a question addressing insulin restriction.5 The mSCOFF has often been applied to support a more rapid screening for routine assessment and care.
However, a positive screen on either survey does not establish a diagnosis, and a negative screen does not rule out a problem.
Potential Inequity with mSCOFF
A recent 2026 study, just published by Newman and colleagues2, examined whether the mSCOFF performed consistently among 130 youth aged 10–18 years with type 1 diabetes.
They cited the potential inequity of screening questions.
The study sample included a retrospective review of mSCOFF questionnaire data for individuals at the University of Tennessee Health Science Center who were 57% Black, 54% female, and had a mean A1C of 10.89%.
The researchers found that both race and sex at birth lead to differential item functioning.
In other words, responses to most screening items reflected different risk levels across groups. This could bias screening classifications. The authors identified the need for future studies to include larger sample sizes and racially and ethnically diverse populations across clinically diverse settings.2 While this study did not establish that the mSCOFF is ineffective in every setting, it did suggest that it can both over- and under-identify individual risk.
Screening results can serve as a starting point for conversation and a comprehensive follow-up assessment.
Open-Ended Nonjudgmental Questions
Diabetes care providers could potentially supplement or replace formal screening with open-ended, nonjudgmental questions about body image, eating behaviors, and insulin use.
A few example questions suggested in the ADA Mental Health Workbook5 included:
- “How do food choices, weight concerns, or diabetes treatment affect how you feel about yourself?”,
- “How do you feel about your body size, shape, or weight?”
- “Have you been trying to change how you eat? If so, in what ways?” and/or
- “Do you ever take less insulin than your diabetes team recommends? If so, could you tell me about it?”.5
These conversations may encourage disclosure and identify concerns that screening scores alone may not detect. Early identification of disordered-eating risk is essential to connect with comprehensive team care.
Ultimately, equitable diabetes care requires looking beyond screening scores, recognizing each individual’s lived experience and need for both diabetes management and emotional well-being.
Christine Craig, MS, RDN, CDCES
Founder: Nutrition for Daily Living
References:
- American Diabetes Association Professional Practice Committee for Diabetes. 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1):S89-S131. doi:10.2337/dc26-S005.
- Newman SN, Berlin KS, Ellison VN, et al. When screening positive for diabetes-specific disordered eating behaviors depends on who you are: unequal mSCOFF flags by race, sex, and HbA1c. Diabetes Obes Cardiometab Care. 2026. doi:10.2337/doc26-0045.
- American Diabetes Association Professional Practice Committee for Diabetes. 14. Children and adolescents: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1):S297-S320. doi:10.2337/dc26-S014.
- American Diabetes Association. Types of eating disorders. Accessed October 18, 2026. https://diabetes.org/health-wellness/mental-health/eating-disorders
- American Diabetes Association. Chapter 8: Eating problems. In: Diabetes and Emotional Health: A Practical Guide for Health Professionals Supporting Adults With Type 1 and Type 2 Diabetes. Accessed October 18, 2026. https://professional.diabetes.org/sites/default/files/media/ada_mental_health_workbook_chapter_8.pdf.
From the Gut to the Butt – Exploring the GI System
1.25 CEs | Nov 13th
Join Beverly Thomassian on November 13th, 2026, at 11:30 am PST
Explore the magnificent world of diabetes and the gut — from periodontal disease to the microbiome and everything in between.
The GI system plays a far bigger role in diabetes than most clinicians realize. Join Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM for a fascinating journey through gastrointestinal health from top to bottom. This course covers fatty liver disease, gastroparesis, intestinal complications of diabetes, the gut microbiome, and more — giving you the knowledge to better support whole-body health. Save your Seat Today!
