Evaluation of eating disorders, kinesiophobia and dysfunctional attitudes in patients with type 2 diabetes mellitus

Aykut Turhan 1 * , Bülent Albayrak 2, Ayşe Çarlıoğlu 3, Nermin Gündüz 4, Havva Tuğba Kiper Yılmaz 5, Nazlıgül Karaüzüm Yalçın 6
More Detail
1 Department of Internal Medicine, Division of Medical Oncology, Ataturk University Hospital, Erzurum, Turkey
2 Department of Internal Medicine, Division of Gastroenterology, Ataturk University Hospital, Erzurum, Turkey
3 Department of Internal Medicine, Division of Endocrinology, Private 100.Year Hospital, Ankara, Turkey
4 Department of Psychiatry, Private Üsküdar University, İstanbul, Turkey
5 Department of Internal Medicine, Muş State Hospital, Muş, Turkey
6 Department of Internal Medicine, Afyon State Hospital, Afyon, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 3, pp. 28-34. https://doi.org/10.23950/jcmk/12109
OPEN ACCESS 590 Views 419 Downloads
Download Full Text (PDF)


Aim: Eating disorders (EDs), dysfunctional attitudes (DAs), and limitation of movement due to kinesiophobia, which are more common in patients with type 2 diabetes mellitus (T2DM), may contribute to poor metabolic control, weight gain, disregard for treatment, and an increased prevalence of microvascular and macrovascular complications; however, current evidence is limited to small studies and restricted measures. In this study, these characteristics were assessed in patients with T2DM relative to controls, and factors independently associated with ED, DA and kinesiophobia were examined.
Material and methods: This case-control study was conducted between July 2018 and December 2018 at the Departments of Endocrinology and Psychiatry of Erzurum Regional Training and Research Hospital, Erzurum, Turkey. A total of 150 patients diagnosed with T2DM and 150 healthy controls were included. The Eating Attitudes Test (EAT), Dysfunctional Attitude Scale (DAS), and Tampa Scale for Kinesiophobia (TSK) were applied.
Results: Median age in the control group was 38 (IQR: 27 - 47) years, and 56 (IQR: 46 - 61) years in the patient group. Women comprised 67.3% of controls and 61.3% of patients. Although all scale scores were higher in the patient group compared to controls, the possible relationships were not confirmed by multiple linear regression analysis. Significant factors independently associated with higher DAS score were high age (p=0.043), high body mass index (p=0.021) and presence of comorbidity (p=0.019). Significant factors associated with higher TSK score were high age (p<0.001) and high BMI (p=0.001). High age (p<0.001) was the only parameter associated with higher EAT score. The presence of T2DM was not found to be an independent factor associated with any of the scores.
Conclusion: Our results show that, rather than the presence of T2DM, other patient characteristics were likely to be more influential on ED, DA and kinesiophobia. These show that older patients with T2DM who have comorbidities or DM-related complications are more likely to benefit from management that account for these characteristics.


Turhan A, Albayrak B, Çarlıoğlu A, Gündüz N, Yılmaz HTK, Yalçın NK. Evaluation of eating disorders, kinesiophobia and dysfunctional attitudes in patients with type 2 diabetes mellitus. J CLIN MED KAZ. 2022;19(3):28-34. https://doi.org/10.23950/jcmk/12109


  • Derya A. and S. Şentürk. Effect of eating attitudes of individuals with type 2 diabetes upon quality of life. International Journal of Health Services Research and Policy. 2020; 5(2):99-110. https://doi.org/10.33457/ijhsrp.726014
  • Dias Santana D., et al. Associations between self-reported diabetes mellitus, disordered eating behaviours, weight/shape overvaluation, and health-related quality of life. Journal of Eating Disorders. 2019; 7(1):1-9. https://doi.org/10.1186/s40337-019-0266-y
  • Ma Y., et al. Association between cognitive vulnerability to depression-dysfunctional attitudes and glycaemic control among in-patients with type 2 diabetes in a hospital in Beijing: a multivariate regression analysis. Psychology, Health & Medicine. 2018; 23(2):189-197. https://doi.org/10.1080/13548506.2017.1339894
  • García-Mayor R.V., F.J. García-Soidán. Eating disoders in type 2 diabetic people: Brief review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017; 11(3):221-224. https://doi.org/10.1016/j.dsx.2016.08.004
  • García-Mayor R.V., A. Larrañaga. Inadequate coping attitudes, disordered eating behaviours and eating disorders in type 1 diabetic patients. Type 1 diabetes. 2011; 1:95-118. https://doi.org/10.5772/22031
  • Herpertz S., et al. Comorbidity of diabetes mellitus and eating disorders: a follow-up study. Journal of psychosomatic research. 2001; 51(5):673-678. https://doi.org/10.1016/S0022-3999(01)00246-X
  • Ozdemir F., et al. Prediction of neuropathy, neuropathic pain and kinesiophobia in patients with type 2 diabetes and design of computerized clinical decision support systems by using artificial intelligence. Medical Hypotheses. 2020; 143:110070. https://doi.org/10.1016/j.mehy.2020.110070
  • Okur I., et al. Musculoskeletal system disorders and kinesiophobia in type 2 diabetes: A case–control study. The Australian Journal of Rehabilitation Counselling. 2021; 27(1):41-49. https://doi.org/10.1017/jrc.2021.1
  • Geelen C., et al. Anxiety affects disability and quality of life in patients with painful diabetic neuropathy. European Journal of Pain. 2017; 21(10):1632-1641. https://doi.org/10.1002/ejp.1067
  • Celik S., et al. Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients. General Hospital Psychiatry. 2015; 37(2):116-119. https://doi.org/10.1016/j.genhosppsych.2014.11.012
  • Sahin N. Bir kültürde fonksiyonel olan tutumlar bir başka kültürde de öyle midir? [Do functional attitudes change from culture to culture?]. Psikoloji Dergisi. 1991; 7(26):30-40.
  • Weissman A.N., A.T. Beck. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. 1978.
  • Yilmaz Ö.T., et al. Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoterapi Rehabilitasyon. 2011; 22(1):44-9.
  • Buyuksireci D.E., M. Buyuksireci. Evaluation of kinesiophobia in patients with metabolic syndrome. Medical Diagnosis and Treatment Methods in Internal Medical Sciences-II: p. 31.
  • Larsson C., et al. Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study. BMC geriatrics. 2016; 16(1):1-8. https://doi.org/10.1186/s12877-016-0224-3
  • Garner D.M., P.E. Garfinkel. The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychological medicine. 1979; 9(2):273-279. https://doi.org/10.1017/s0033291700030762
  • Erol N., S.I.Y.T. Testi. Anoreksia nevroza belirtileri indeksi. Türk Psikoloji Dergisi. 1989; 23:132-6.
  • Üşenmez T.Y., H.A. Sürücü, M. Sungur. The contribution of self esteem and self-care behaviors to the eating attitudes: A correlational study in type 2 diabetes patients. 2021.
  • Engelgau M.M., et al. The evolving diabetes burden in the United States. Annals of internal medicine. 2004; 140(11):945-950. https://doi.org/10.7326/0003-4819-140-11-200406010-00035
  • Sullivan P.W., et al. Obesity, inactivity, and the prevalence of diabetes and diabetes-related cardiovascular comorbidities in the US, 2000–2002. Diabetes care. 2005; 28(7):1599-1603. https://doi.org/10.2337/diacare.28.7.1599
  • Boden G., X. Chen. Effects of fat on glucose uptake and utilization in patients with non-insulin-dependent diabetes. The Journal of clinical investigation. 1995; 96(3):1261-1268. https://doi.org/10.1172/JCI118160
  • Samadi A., et al. A Comprehensive Review on Oxysterols and Related Diseases. Curr Med Chem. 2021; 28(1):110-136. https://doi.org/10.2174/0929867327666200316142659
  • Nicolau J., et al. Eating disorders are frequent among type 2 diabetic patients and are associated with worse metabolic and psychological outcomes: results from a cross-sectional study in primary and secondary care settings. Acta Diabetologica. 2015; 52(6):1037-1044. https://doi.org/10.1007/s00592-015-0742-z
  • Lou Q., et al. Diabetes attitude scale: Validation in type-2 diabetes patients in multiple centers in China. Plos one. 2014; 9(5):e96473. https://doi.org/10.1371/journal.pone.0096473
  • Stein D. and A.M. Grant. Disentangling the relationships among self-reflection, insight, and subjective well-being: The role of dysfunctional attitudes and core self-evaluations. The Journal of psychology. 2014; 148(5):505-522. https://doi.org/10.1080/00223980.2013.810128
  • Petersen T., et al. Clinical characteristics of depressed patients with comorbid diabetes mellitus. International clinical psychopharmacology. 2006; 21(1):43-47. https://doi.org/10.1097/01.yic.0000182122.36425.b1
  • Vlaeyen J.W., et al. The role of fear of movement/(re) injury in pain disability. Journal of occupational rehabilitation. 1995; 5(4):235-252. https://doi.org/10.1007/BF02109988
  • Goodwin R.D., C.W. Hoven, and R.L. Spitzer. Diabetes and eating disorders in primary care. International Journal of Eating Disorders. 2003; 33(1):85-91. https://doi.org/10.1002/eat.10106
  • Cerrelli F., et al. Eating behavior affects quality of life in type 2 diabetes mellitus. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2005; 10(4):251-257. https://doi.org/10.1007/BF03327492
  • Meneghini LF, Spadola J, Florez H. Prevalence and associations of binge eating disorder in a multiethnic population with type 2 diabetes. Diabetes Care. 2006; 29(12):2760. https://doi.org/10.2337/dc06-1364