Scholars@Duke publication: Diabetes Distress and Glycemic Stability: The Mediating Role of Experiential Avoidance and Disordered Eating in Type 1 Diabetes.

Diabetes Distress and Glycemic Stability: The Mediating Role of Experiential Avoidance and Disordered Eating in Type 1 Diabetes.

Publication , Journal Article

Roberts, MZ; Moskovich, AA; Scheiber, FA; Merwin, RM

Published in: J Behav Med

February 2026

Type 1 diabetes (T1D) is chronic and demanding, often associated with high levels of diabetes distress, which in turn, is associated with elevated hemoglobin A1c (HbA1c). The current study examines whether the relationship between diabetes distress and HbA1c is mediated by disordered eating behaviors (DEBs) which may function to help the individual avoid or escape the emotional distress of living with diabetes. N = 75 adults with T1D and varying levels of disordered eating completed measures of diabetes distress (DDS), experiential avoidance of diabetes-related thoughts and feelings (AADQ), and disordered eating behaviors (DEPS-R). They also completed a blood draw to assess HbA1c. All variables were moderately positively associated. The relationship between diabetes distress and HbA1c was fully mediated by experiential avoidance and DEBs, controlling for age and years since T1D diagnosis. Findings support the theoretical conceptualization of DEBs as one form of avoidance and escape from diabetes distress, in turn affecting HbA1c. Results suggest that increasing openness to unwanted thoughts and feelings surrounding diabetes could reduce DEB and improve glycemic stability.