Caring for individuals with Type 1 Diabetes Mellitus who restrict and omit insulin for weight control: Evidence-based guidance for healthcare professionals

Goddard, Georgia; Oxlad, Melissa

doi:10.1016/j.diabres.2022.109783

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…Disabled individuals may experience barriers to accessing treatment, including physically inaccessible facilities with insufficient space for mobility aids [ 33 ]. Patients with multiple chronic illnesses receiving ED treatment may encounter ED treatment staff who do not understand or account for their co-occurring chronic illnesses in the delivery of ED treatment [ 34 , 35 ]. Programming and treatment modalities can be unwilling or unable to accommodate sensory and cognitive needs of neurodivergent people [ 22 , 36 ].…”

Section: Systemic Oppression and Barriers To Carementioning

confidence: 99%

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa

Sharpe¹,

Adams²,

Smith³

et al. 2023

J Eat Disord

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Informed by our lived experiences with eating disorders, our work providing direct support to communities underserved by existing healthcare structures, and our commitment to social justice, we are deeply troubled by several aspects of the proposed characteristics for “terminal” anorexia nervosa outlined by Gaudiani et al. in Journal of Eating Disorders (10:23, 2022). We have identified two substantial areas of concern in the proposed characteristics provided by Gaudiani et al. and the subsequent publication by Yager et al. (10:123, 2022). First, the original article and the subsequent publication fail to adequately address the widespread inaccessibility of eating disorder treatment, the lack of parameters for what constitutes “high quality care”, and the prevalence of trauma experienced in treatment settings for those who do access treatment. Second, the characteristics proposed for “terminal” anorexia nervosa are constructed largely based on subjective and inconsistent valuations of suffering which build on and contribute to harmful and inaccurate eating disorder stereotypes. Overall, we believe these proposed characteristics in their current form stand to detract from, rather than assist, the ability of patients and providers to make informed, compassionate, and patient-centered decisions about safety and autonomy both for individuals with enduring eating disorders and for individuals with more recently diagnosed eating disorders.

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Section: Systemic Oppression and Barriers To Carementioning

confidence: 99%

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa

Sharpe¹,

Adams²,

Smith³

et al. 2023

J Eat Disord

View full text Add to dashboard Cite

show abstract

“…Eating disorders among patients with type 1 diabetes may manifest as the misuse of diabetes medications, i.e., insulin [ 79 ]. Patients with type 1 diabetes mellitus may intentionally reduce or omit doses of insulin to lose weight.…”

Section: Glucose Homeostasismentioning

confidence: 99%

“…Omitting insulin results in a catabolic state because it reduces the amount of glucose that can enter cells; instead, proteins and fats are broken down for energy and glucose is excreted in the urine. Although the reduction or omission of insulin in patients with type 1 diabetes mellitus and eating disorders is associated with very high morbidity and mortality, evidence-based guidance on its treatment is needed, as standard eating disorder treatment models are not effective [ 79 ].…”

Section: Glucose Homeostasismentioning

confidence: 99%

Endocrine complications of anorexia nervosa

Haines

2023

J Eat Disord

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An important component in the treatment of anorexia nervosa (AN) is the evaluation and management of its endocrine complications, including functional hypogonadotropic hypogonadism and increased fracture risk. The body’s adaptive response to chronic starvation results in many endocrine abnormalities, most of which are reversible upon weight restoration. A multidisciplinary team with experience in treating patients with AN is critical to improving endocrine outcomes in patients with this disorder, including in women with AN who are interested in fertility. Much less is understood about endocrine abnormalities in men, as well as sexual and gender minorities, with AN. In this article, we review the pathophysiology and evidence-based recommendations for the treatment of endocrine complications in AN, as well as discuss the status of clinical research in this area.

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“…This is a previously ignored patient population with a high risk of irreversible consequences and poor experience of services. [34][35][36][37] Risk management had significant shortcomings. Only around 40% of services could provide complete medical monitoring and had good links with acute hospitals.…”

Section: Capacity Of Aceds To Meet the Nhse Guidance For Commissioner...mentioning

confidence: 99%

The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19

et al. 2023

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Aims/method This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Results Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. Clinical implications This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

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Caring for individuals with Type 1 Diabetes Mellitus who restrict and omit insulin for weight control: Evidence-based guidance for healthcare professionals

Cited by 7 publications

References 34 publications

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa

Endocrine complications of anorexia nervosa

The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19

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