University of Warwick fully-funded PhD studentship exploring development and testing of a screening tool for Eating Disorders in Type 1 Diabetes patients 

We are looking for a motivated MSc graduate in health or medical disciplines with experience in quantitative and qualitative research methods and an interest in the areas of endocrinology, epidemiology and health/clinical psychology. 

Project Description 

There is consistent evidence of elevated rates of eating disorders in young women with type 1 diabetes compared to their healthy counterparts. Once established, these conditions carry very poor prognoses, principally because of the use of insulin restriction as a means of weight control. Around 40% of young women with type 1 diabetes admit to insulin restriction; this is associated with impaired blood glucose control and an increased incidence of both acute and chronic complications, as well as a significantly elevated mortality. Estimates of the prevalence of eating disorders in type 1 diabetes range from 5 to 25.6% and binge eating disorder is by far the most common diagnosis. 

The combination of an eating disorder and diabetes poses a unique set of diagnostic and therapeutic challenges and has traditionally been thought of as high risk and difficult to treat. The mortality in those with both anorexia nervosa and type 1 diabetes is 35% over 10 years; this is three times greater than those with only type 1 diabetes and fifteen times that of people with neither condition. 

Clinical experience indicates that a significant number of those with an eating disorder and diabetes experience high levels of shame and stigma and therefore do not present to treatment. Systematic case finding for eating disorders does not occur routinely in diabetes services, despite clear direction from NICE about best practice in the care of treatment of people with this type of co-morbidity. A national survey found that only one third of UK diabetes services judged themselves capable of meeting NICE guidelines for the identification and treatment of diabetic patients with eating disorders. Diabetes professionals often lack the skills to identify patients who may have an eating disorder and the confidence to explore this with them. There is currently no simple, validated screening measure for eating disorders in people with diabetes, which can be administered as part of a routine consultation by a diabetes professional without specific training. 

Research objectives and methods 

The project will develop an easy to use screening tool for eating disorders in both type 1 and type 2 diabetes, which can be used in a busy clinical setting by diabetes professionals without specialist training. In the first stage, the study will refine existing questions on the Screen for Eating Disorders in Diabetes (SEDD) through focus groups of PWDs and professionals and cross-validate it against a standard clinical interview measure for eating disorders. 

In the second stage, we will undertake a qualitative process evaluation to explore the views of stakeholders concerning the feasibility and acceptability of administering the SEDD in routine clinical practice, including perceptions of the potential impacts of false positive screen results and the effects of screening on engagement with diabetes services. 

Research outputs and impact 

We expect this project to lead to a minimum of three peer-reviewed articles including a review. The study will also facilitate grant applications to fund Phase 2 of the study (evaluation of the reliability and validity of the scale and cost-predictive analyses using the tool in routine clinical practice). 

The validation of the screening tool will provide an opportunity to develop a programme of training in eating disorders and diabetes at the University of Warwick. There is currently no such training available but Dr Winston's (consultant and industry lead) experience of teaching diabetes professionals, on Warwick Medical School’s Diabetes programmes and elsewhere, indicates both a need and a demand for this. 

Longer term, the new instrument will make it possible to screen people with type 1 diabetes for the presence of an eating disorder as part of normal clinical care. This will enable more patients to be offered treatment. This will in turn have a positive impact on the level of illness and death rates in this group. It will also reduce the number of admissions in type 1 diabetes and thereby reduce costs to the NHS. In future, it will make it easier to test out new treatments for eating disorders in people with diabetes. 

How to apply 

Please send a CV, personal statement and two references to wms.rdcoord@warwick.ac.uk. 

The deadline for applications is Friday 8 December 2023. Interviews will likely take place w/b Monday 11 December. 

Enquiries 

For general enquiries about the project, please contact Dr Talar Moukhtarian –Talar.moukhtarian@warwick.ac.uk or Dr Carla Toro - carla.toro@warwick.ac.uk.