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Eating Disorder in Type 1 Diabetes and Factors of Insulin Limitation

Findings suggest that helping patients respond effectively to eating disorder symptoms might decrease insulin restriction.

Patients with T1DM who limit insulin to control weight are at greater risk for diabetes-related complications and premature death. Nonetheless, not much is known about this mannerism or how to effectively manage patients with this condition. Therefore, researchers conducted a study to identify predictors of insulin restriction in the natural environment that might inform new treatment directions.

Researchers evaluated 83 adults with T1DM and a range of eating disorders. Subjects in the study reported emotions, eating, and insulin dosing throughout the day using cellular devices. To estimate the effects of heightened negative affects such as anxiety, linear mixed models were utilized. These characteristics were measured before eating to identify the effect on the eating episode such as eating large amounts of food.

Furthermore, this information was used to analyze the risk of insulin restriction.

Researchers found that individuals who reported greater-than-average negative affects were more likely to restrict insulin. Brief increases in anxiety/nervousness and guilt/disgust with self before eating further increased the odds of restricting insulin at the next meal. This was more likely when subjects reported that they broke a dietary rule such as no desserts.

Authors believe that helping patients with T1DM respond effectively to eating disorder symptoms might decrease insulin restriction. Specifically, this would involve helping patients respond effectively to heightened negative affects (such as anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.

Practice Pearls:

  • Healthcare professionals who help T1DM patients respond effectively to eating disorder symptoms might decrease insulin restriction.
  • Specifically, when individuals respond more effectively to heightened negative affects (e.g. anxiety, guilt), better control may be observed.
  • Patients should be encouraged to take a less rigid, punitive approach to diabetes management.

Merwin, Rhonda M., et al. “Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology.” Diabetes care 38.11 (Sep 17 2015): 2025-2032.