OBJECTIVE -To determine whether insulin restriction increases morbidity and mortality in women with type 1 diabetes. RESEARCH DESIGN AND METHODS-This is an 11-year follow-up study of women with type 1 diabetes. A total of 234 women (60% of the original cohort) participated in the follow-up. Mean age was 45 years and mean diabetes duration was 28 years at follow-up. Mean BMI was 25 kg/m 2 and mean A1C was 7.9%. Measures of diabetes self-care behaviors, diabetesspecific distress, fear of hypoglycemia, psychological distress, and eating disorder symptoms were administered at baseline. At follow-up, mortality data were collected through state and national databases. Follow-up data regarding diabetes complications were gathered by selfreport.RESULTS -Seventy-one women (30%) reported insulin restriction at baseline. Twenty-six women died during follow-up. Based on multivariate Cox regression analysis, insulin restriction conveyed a threefold increased risk of mortality after controlling for baseline age, BMI, and A1C. Mean age of death was younger for insulin restrictors (45 vs. 58 years, P Ͻ 0.01). Insulin restrictors reported higher rates of nephropathy and foot problems at follow-up. Deceased women had reported more frequent insulin restriction (P Ͻ 0.05) and reported more eating disorder symptoms (P Ͻ 0.05) at baseline than their living counterparts.CONCLUSIONS -Our data demonstrate that insulin restriction is associated with increased rates of diabetes complications and increased mortality risk. Mortality associated with insulin restriction appeared to occur in the context of eating disorder symptoms, rather than other psychological distress. We propose a screening question appropriate for routine diabetes care to improve detection of this problem.

This study examined intertask consistency in handedness across multiple measures of hand use in a sample of 187 chimpanzees (Pan troglodytes). Hand preferences for 2 to 6 measures were collected from the sample, and hand preference scores were derived on the basis of the individual hand preferences for each measure. Seven of 15 possible intratask correlations were significant, with some degree of clustering depending on the motor demands of the tasks. Two overall measures of handedness revealed population-level right-handedness in the chimpanzees, although the degree of bias was reduced for chimpanzees tested on more than 3 measures of hand use. The results are interpreted in the context of several recent studies that proposed theoretical models of handedness in nonhuman primates.Approximately 90% of humans report themselves as being right-handed (Annett, 1985;Porac & Coren, 1981). The historical view has been that nonhuman animals, particularly nonhuman primates, do not exhibit population-level handedness (see Ettlinger, 1988;Lehman, 1993;Warren, 1980). In recent years, behavioral research in a variety of nonhuman primate species using a multitude of tasks has revealed that population-level handedness can be found in some species for certain measures (Bradshaw & Rogers, 1993;Hopkins, 1996;Ward & Hopkins, 1993). In addition to handedness, evidence of perceptual and cognitive asymmetries in a host of animal species has been reported (Bisazza, Rogers, & Vallortigara, 1998;Bradshaw & Rogers, 1993). These cumulative data clearly challenge the historical view purporting the uniqueness of hemispheric specialization to humans.With the emergence of evidence of hemispheric specialization and handedness in animals, a fundamental question has arisen: Is the manifestation of handedness in animals the same as in humans? Corballis (1992) has suggested that nonhuman primate handedness reflects a "weaker" form of handedness than is evident in humans. Roney and King (1993) have made a similar argument with respect tO differences between human and nonhuman primate handedness. More recently, Marchant (1994,1997) have dichotomized laterality of hand functions on the basis of consistency in use within and between subjects and tasks. Specifically, according to McGrew and Marchant (1997), hand preference refers to within-task and within-subject variability in hand preference. Task specialization refers to situations in which most individuals within a sample show the same hand preference for one and only one measure. Manual specialization refers to circumstances in which the same individual uses the same hand across task, but all individuals within that sample show inconsistent preferences. Finally, true handedness reflects consistent hand use across all measures and individuals in a sample. McGrew and Marchant 1997) argued that most studies in nonhuman primates have failed to meet their definition of true handedness, and most fall into the categories of either Byrne & Byrne, 1991;Diamond & McGrew, 1994). Thus, according to...

OBJECTIVETo determine the distinguishing characteristics of women who report stopping insulin restriction at 11 years of follow-up from those continuing to endorse insulin restriction as well as those characteristics differing in patients who continue to use insulin appropriately from new insulin restrictors.RESEARCH DESIGN AND METHODSThis is an 11-year follow-up study of 207 women with type 1 diabetes. Insulin restriction, diabetes self-care behaviors, diabetes-specific distress, and psychiatric and eating disorder symptoms were assessed using self-report surveys.RESULTSOf the original sample, 57% participated in the follow-up study. Mean age was 44 ± 12 years, diabetes duration was 28 ± 11 years, and A1C was 7.9 ± 1.3%. At follow-up, 20 of 60 baseline insulin restrictors had stopped restriction. Women who stopped reported improved diabetes self-care and distress, fewer problems with diabetes self-management, and lower levels of psychologic distress and eating disorder symptoms. Logistic regression indicated that lower levels of fear of weight gain with improved blood glucose and fewer problems with diabetes self-management predicted stopping restriction. At follow-up, 34 women (23%) reported new restriction, and a larger proportion of new insulin restrictors, relative to nonrestrictors, endorsed fear of weight gain with improved blood glucose.CONCLUSIONSFindings indicate that fear of weight gain associated with improved blood glucose and problems with diabetes self-care are core issues related to both the emergence and resolution of insulin restriction. Greater attention to these concerns may help treatment teams to better meet the unique treatment needs of women struggling with insulin restriction.