Background: Eating disorders (ED) and disordered eating (DE) affect up to 34%1 and 50%2 of people with type 2 diabetes (T2D), respectively, globally. Alongside the negative biopsychosocial effects of these mental health conditions, ED/DE effect engagement with, and the appropriateness of, diabetes self-management, including dietary advice. Yet screening is not routinely embedded in diabetes care or research. CARE-T2D is a fully remote randomised controlled trial of continuous glucose monitoring (CGM) and dietetic support. This analysis describes the outcomes of ED/DE screening during recruitment to the CARE-T2D trial.
Methods: Adults across Australia with non-insulin-managed T2D and HbA1c ³7.0% were recruited online. Eligibility screening included post-consent clinical criteria (HbA1c, no recent CGM use <6 months) and DE risk (EDE-Q) prior to baseline assessments, then randomisation. People identified as being at high risk of ED/DE (EDE-Q global score≥2.8, or psychopathology score≥1.52 plus≥4 on behavioural items (Q14-18)) were excluded and provided with information about support options.
Results: From April 2025 to May 2026, 1,553 expressions of interest were received; n=1124 (72%) were excluded pre-consent and n=248 (16%) post-consent, and n=160 (10%) randomised. Pre-consent exclusions were due to non-response, insulin use, current/recent CGM use, or HbA1c <7.0%; no potential participants self-identified with an ED. Post-consent exclusions included n=97 (7% of exclusions, 23% consented participants) identified as being at high risk of ED/DE: 47% (n=46) met the EDE-Q threshold for probable ED, and 53% (n=51) for DE behaviours.
Conclusion: Screening within a remote T2D trial identified a meaningful proportion of adults who may require further ED/DE assessment and support. The discrepancy between self-identified ED and screening outcomes suggests that undiagnosed ED/DE may be common in adults with T2D. Routine screening protocols and integrated ED/DE care pathways are needed within T2D management. Further research is also needed to better understand the interplay between T2D, diabetes self-management, and ED/DE, as well as referral pathways for appropriate management.