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Exploring the relationship between eating behaviour, carbohydrate counting and risk of disordered eating in patients with Type 1 diabetes mellitus.

   Bristol Medical School

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  Dr E Hinton  Applications accepted all year round  Self-Funded PhD Students Only

About the Project

A key component of current Type 1 diabetes management is carbohydrate counting. This method has been demonstrated to improve blood glucose (glycaemic) control in children and adults with Type 1 diabetes mellitus (T1DM; 1). Carbohydrate counting is complex and time consuming and issues with adherence have been reported (2). It has been suggested that the consistent awareness of food intake may have negative effects on people with T1DM (3). There is considerable evidence suggesting an increased risk of eating disorders in adolescents and adults living with Type 1 diabetes compared to the general population (4).

A wealth of research into cognitive and psychological mechanisms underlying eating behaviour in the general population has revealed numerous important concepts, such as restraint (5), food reward (6), memory for recent eating (7) and portion size control (8), that may be relevant to understanding eating habits in those with T1DM. This novel research proposal plans to apply the literature on the psychological underpinnings of eating behaviour and related cognitions to understand the potential impact of carbohydrate counting on risk of disorder eating in young people with Type 1 diabetes.

Aims and objectives

The aim is to explore the potential links between carbohydrate counting, eating habits, cognitions, and risk of eating disorders in T1DM. The objectives are to conduct:

  1. patient and public involvement (PPI) sessions to ensure the patient voice is central to this research.
  2. a scoping review on carbohydrate counting and adverse eating behaviours,
  3. qualitative interviews to assess patient experiences around these concepts,
  4. cross-sectional eating behaviour studies in children and young adults with T1DM,
  5. a longitudinal study to investigate the transition of responsibility of carbohydrate counting from parent to child with T1DM, and potential impact on eating.


A mixed methods approach will be taken in this project to provide a wide breadth of training opportunities for the student.

  1. Qualitative methods will be used to gain the patient and parent/carer perspective. Semi-structured interviews will be analysed using thematic analysis.
  2. Visits to clinics will allow understanding of clinical practice in psychological and endocrinology, experienced by patients (through supervisory team).
  3. Technical skills will be developed through the design and implementation of protocols from experimental psychology (food intake, psychological questionnaires and tasks) to conduct both cross-sectional, and longitudinal eating behaviour studies with collaborators in the Nutrition and Behaviour Unit in Psychology
  4. Statistical and qualitative methodological support can be accessed as needed through the NIHR Bristol Biomedical Research Centre, Diet and Physical Activity theme.
  5. PPI, supported by the primary supervisor, will be incorporated during design, interpretation, and dissemination. This will allow the student to develop good skills in communication with patients and their carers.

Apply for this project

This project will be based in Bristol Medical School - Translational Health Sciences.

Please contact for further details on how to apply.

Apply now!


1. Bell KJ et al. (2014) Lancet Diabetes Endocrinol, 2(2):133-40.
2. Bayram S, Kiziltan G & Akin O. (2020) Ann Pediatr Endocrinol Metab, 25:156-162.
3. Goebel-Fabbri A, et al. (2019) Journal of Eating Disorders, 7, 27.
4. Jones, J. M., Lawson, M. L., Daneman, D., Olmsted, M. P., & Rodin, G. (2000). British Medical Journal, 320(7249), 1563–1566.
5. Stunkard, A.J. and Messick, S. (1985) Journal of Psychosomatic Research, 29, 71-83.
6. Hunot C, et al. (2016) Appetite, 1;105:356-63.
7. Higgs S & Spetter MS (2018) Current Obesity Reports, 7:50–59.
8. Brunstrom JM & Shakeshaft NG. (2009) Appetite, 52(1):108-14.
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