​​By: Michelle Lee Hoy, Senior Communications Specialist, Oak Valley Health 

At Oak Valley Health’s Paediatric Diabetes Clinic (PDC), the care team sees firsthand the pressures young people face as they manage type 1 diabetes (T1D). For many adolescents, keeping track of carbs, insulin, and blood sugars is not just a routine — it’s a daily responsibility that can shape how they think about food, eating, and their bodies.

Clinical guidelines recommend annual screening for disordered eating behaviours (DEBs) in adolescents with T1D to identify early risk factors and prevent progression to a clinical eating disorder. However, behaviours such as binge eating, skipping meals, eating outside prescribed schedules, or alternating between very small and very large portions, commonly associated with this patient population, do not meet diagnostic criteria for a formal eating disorder. Despite this, these patterns still carry real risks, affecting both glycemic management and overall mental health.

Grounded in a commitment to putting patients and families at the centre of care, the PDC recognized that excellent outcomes require more than strong biomedical metrics alone. The clinic advocated for and led routine screening for disordered eating behaviours (DEBs), embedded directly into standard clinical care. 

Adolescents aged 12 to 18 years, as well as those recently transitioned out of paediatric care, were screened as part of their routine visits. This approach acknowledged that diabetes management itself — monitoring food intake, timing meals around insulin, and responding to glucose fluctuations — can increase vulnerability to disordered eating behaviours simply due to the nature of the disease and the lifestyle impacts.

Over 15 months, 208 young people took part. As the team reviewed their stories and experiences, one message stood out: good glucose numbers don’t mean a teen isn’t struggling. One of the most significant findings was the link with ADHD. Teens with ADHD were 4.5 times more likely to show signs of disordered eating — not because ADHD is tied to diabetes, but because difficulty focusing, regulating habits, or sticking to routines can complicate both diabetes care and eating patterns. 

When a patient was identified through this screening as needing support, help was offered right away. Clinicians provided onthespot counselling, written information to take home, referrals to social work, and webinars for both parents and teens. 

The team also saw that teens who felt happier and more supported in their daily lives, those with higher quality-of-life scores, were less likely to show signs of disordered eating. Emotional wellbeing played a protective role. 

DEB screening results and quality-of-life questionnaires now provide a meaningful clinical lens that complements existing care practices. A diagnosis of ADHD may prompt a more detailed psychosocial assessment and evaluation of disordered eating behaviours. While ADHD is not independently associated with T1D, its effects on executive functioning — attention, impulse control, planning, and routine adherence — may impact the complexity of diabetes self-management and eating patterns. 

Today, among roughly 35 paediatric diabetes programs in Ontario, Oak Valley Health’s PDC is the only one that screens routinely and systematically for disordered eating behaviours. The work was led by the clinic’s social worker, built without dedicated research funding, and has already been shared across the province to help other programs strengthen their own supports. 

What started as a simple question has become a powerful example of how listening closely to patients can drive meaningful change. By understanding the emotional and behavioural side of diabetes, not just the numbers, the PDC team is offering care that sees the whole patient, not just their diagnosis. 

As the Paediatric Diabetes Clinic continues to refine and expand this approach, the initiative stands as a clear example of how Oak Valley Health’s strategic priorities — patient-centred care, integration, innovation, and learning — translate into meaningful improvements for patients, families, and the broader health system.