NSW Disordered Eating and Eating Disorders in Children, Adolescents, and Adults with Type 1 Diabetes Guideline

The NSW Disordered Eating (DE) and Eating Disorders (ED) in Children, Adolescents, and Adults with Type 1 Diabetes guideline provides comprehensive, evidence-informed clinical guidance for the identification, prevention, assessment, and management of DE/ED in individuals with Type 1 Diabetes (T1D) across the lifespan. Adapted from Queensland Health’s 2022 guidelines and revised and updated by a NSW Health Working Party, it reflects current best practice and expert consensus. 

Purpose and scope 

This guideline supports clinicians across disciplines — medical, mental health, nursing, dietetics, and diabetes education — in delivering safe, person-centred care for individuals with T1D who experience DE/ED. It emphasises: 

• Early identification and intervention through routine psychosocial screening. 

• Interdisciplinary collaboration between diabetes and mental health teams, ensuring the person is at the centre of care. 

• Weight-neutral, stigma-free care to reduce harm and improve engagement. 

• Tailored treatment approaches that consider individual, cultural, and resource contexts. 

This guideline has been written predominantly for clinicians working with people with T1D who may experience DE or ED rather than for eating disorder clinicians who may see someone with T1D. Eating disorder clinicians will find the information contained in the document helpful as it will inform them how to work collaboratively with the diabetes team should they be involved in the care of an individual with T1D. 

Guidance on the inpatient treatment for individuals with T1D is out of scope of these guidelines; the focus is on outpatient and community-based care. 

Aims 

This guideline has been designed as a reference tool rather than a document to read end-to-end. Some sections are organised by discipline for easy access. 

A key principle is integrating mental health clinicians into diabetes teams to enhance communication, collaboration, and shared goals with individuals and their families. Resource availability varies across NSW, so local adaptation may be required. 

As stated in the NSW Service Plan for People with Eating Disorders (2021-2025), ED are core business for all NSW Health clinicians, not just the role of the mental health clinician. This guideline equips diabetes clinicians to confidently address DE, using appropriate language, assessment, and treatment strategies, while avoiding harm. It also promotes awareness of weight stigma and encourages weight-neutral, person-centred care. 

Clinical guidance 

• Screen for DE/ED at diagnosis, annually, and when risk indicators are present. 

• Use validated tools such as DEPS-R for diabetes-specific screening. 

• Apply trauma-informed, culturally safe care, particularly for Aboriginal people, recognising holistic health and the impact of intergenerational trauma. 

• Ensure a collaborative interdisciplinary team working approach to provide safe, individualised, and targeted assessment and management of the dual T1D and DE/ED diagnosis, with the knowledge that misuse of insulin is a unique compensatory behaviour that may be present. 

• Individualise treatment plans, incorporating medical, nutritional, and psychological interventions concurrently.