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T1DE currently lacks a clear definition, diagnostic differentiation into phenotypes and clinical severity grading, which results in exclusion of people with T1DE from accessing appropriate treatments to improve outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed anonymised T1DE case vignettes from the baseline assessments of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY) and the London-T1DE pilot service at King\u2019s College Hospital for people with diabetes and severe eating disorder, integrating detailed biomedical and psychiatric data. In an iterative process, phenotypes of T1DE were developed, the T1DE vignettes were sorted into the different phenotypes and a clinical severity grading framework was developed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 70 participants (94.3% women) were 34.5\u00a0\u00b1\u00a010.6 years old with a diabetes duration of 18.4\u00a0\u00b1\u00a012.5 years and HbA\n                      <jats:sub>1c<\/jats:sub>\n                      of 84.8\u00a0\u00b1\u00a032.9 mmol\/mol (10.2\u00a0\u00b1\u00a03.0%). All but one fulfilled ICD-10\/Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for a formal eating disorder diagnosis, 34 met criteria for other specified feeding or eating disorder, 27 for bulimia nervosa, six for anorexia nervosa and two for binge eating disorder. Over 50% had a mood disorder, 44.3% an anxiety disorder and 20.0% a trauma-related disorder. From the anonymised T1DE vignettes generated, three main T1DE phenotypes with subtypes emerged: insulin-omission (diabulimia) T1DE (28 participants, 40.0%), characterised by near total insulin omission in intention to lose weight, with (binge\u2013)purge, anorectic and cyclical subtypes; restrict T1DE (17, 24.3%), characterised by restriction of food\/carbohydrates (with [binge\u2013]purge, anorectic and hypo subtypes); and binge T1DE (25, 35.7%), characterised by subjective or objective binge eating with or without omission of bolus insulin (with binge\u2013purge, binge-only and hypo subtypes). Severity grading categorised 19 cases (27.1%) as \u2018low\u2019, 23 (32.9%) as \u2018moderate\u2019 and 28 (40.0%) as \u2018severe\u2019 clinical risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>The three T1DE phenotypes will serve as a basis for more precise clinical diagnosis and severity grading and will be used to develop future diagnostic screening tools, improved psychological interventions and integrated treatment care pathways to match the individual clinical presentation and severity in a personalised medicine approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06756-9","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:27:24Z","timestamp":1779809244000},"page":"2155-2167","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical and psychological phenotypes of type 1 diabetes and disordered eating derived from a case vignette series: T1DE phenotypes"],"prefix":"10.1007","volume":"69","author":[{"given":"Divina","family":"Pillay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8894-7271","authenticated-orcid":false,"given":"Nadine","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3771-9735","authenticated-orcid":false,"given":"Amy","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1720-1621","authenticated-orcid":false,"given":"Natalie","family":"Zaremba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7205-285X","authenticated-orcid":false,"given":"Emmanouela","family":"Konstantara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4400-5498","authenticated-orcid":false,"given":"Pil","family":"Lindgreen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Allan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miranda","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0871-4596","authenticated-orcid":false,"given":"Janet","family":"Treasure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6084-449X","authenticated-orcid":false,"given":"Khalida","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6869-9960","authenticated-orcid":false,"given":"Marietta","family":"Stadler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"issue":"7249","key":"6756_CR1","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1136\/bmj.320.7249.1563","volume":"320","author":"JM Jones","year":"2000","unstructured":"Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000) Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. 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Willaing Tapager and B. Cleal (Steno Diabetes Center Copenhagen, Denmark) for hosting one of the international T1DE workshops under the umbrella of STENO Diabetes Copenhagen. We are very grateful to our colleagues who participated in the workshops feeding in the phenotype definitions of T1DE.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"The case vignette series the phenotype analysis is based on is shared in the\n                      \n                      . Source data for the case vignette development cannot be shared for confidentiality reasons. Biomedical and anthropometric data can be shared upon request (corresponding author) for the purposes of systematic reviews and meta-analyses.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"This work was conducted as part of the National Institute for Health Research (NIHR; CS-2017-17-023)-funded STEADY project (Safe management of people with Type 1 diabetes and EAting Disorders studY). NZ\u2019s salary was part-funded by the NIHR via the NIHR Clinician Scientist Award to MS; JT and KI are part-funded by the NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King\u2019s College London. MS was funded through an NIHR Clinician Scientist Fellowship (CS-2017-17-023). AH\u2019s and JB\u2019s salaries were in part funded by the NIHR Clinician Scientist Award to MS. EK was funded through a KCH-KMRT JRC PhD student fellowship. The workshop laying the foundation to this work in 2022 was financially supported by the Danish Diabetes Association.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work. PL owns stock in Novo Nordisk. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors' relationships and activities"}},{"value":"MS designed the analysis plan and protocol for this work, MS, DP and AH conducted the STEADY data collection and research interviews, and KI, MR, JB, DT and MS conducted the clinical assessments and data collections that formed the basis for the London-T1DE vignettes. NP and DP led on the case vignette series development. EK and NZ contributed to data collection, extraction and analyses. MS, DP and PL led on the phenotype analyses. JA and NZ critically reviewed the case vignette series. MR, JT, KI, PL, DT, AH, NZ, MS, DP and NP contributed to phenotype analyses. DP, NP and MS drafted the article, and all authors critically reviewed the article and approved the final version. MS and DP had full access to the datasets. MS is the guarantor of this work.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}