Improvement and Emergence of Insulin Restriction in Women With Type 1 Diabetes

Abstract

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.

Dealing with the devil: weight loss concerns in young adult women with type 1 diabetes

“…, Goebel‐Fabbri et al . ). Eating disorders more generally (in people with and without diabetes) appear to be associated with increased risk of suicide (Rome et al .…”

“…We sought to address these questions/research gaps using a qualitative approach, which diabetes researchers have argued is particularly suitable for gaining a better understanding of young women's perspectives on these issues (Goebel‐Fabbri et al . ).…”

“…We lack a sufficient understanding of the natural history of disordered eating in young women with type 1 diabetes, in particular what leads them to develop disturbed weight loss behaviours and what leads them to desist from these behaviours once they have developed them (Goebel‐Fabbri et al . , Young‐Hyman & Davis , Powers et al . ).…”

Disordered Eating Behaviors Are Associated with Poorer Diet Quality in Adolescents with Type 1 Diabetes

“…6 In a five-year longitudinal study of adolescent girls with T1D, weight concerns significantly predicted the onset of disordered eating behaviors, 7 and an eleven-year study of adult women with T1D showed that greater fear of weight gain was associated with higher risk of insulin restriction. 8 The epidemic of childhood overweight and obesity has not spared youth with T1D, with rates of overweight and obese similar to the general population. 9 Research early in the advent of intensive insulin therapy found weight gain to be associated with regimen intensification, 10–12 though the extent to which these findings apply to contemporary insulin therapy is not known.…”

Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes

“…The prevalence of intentional insulin omission among individuals with type 1 diabetes suggests that there might be unique features of this chronic illness that increase the risk for engaging in maladaptive weight control strategies. One factor may be increased body dissatisfaction among individuals with type 1 diabetes due to the weight gain associated with insulin therapy, combined with a highly effective method for weight loss [15]. However, interventions that effectively decrease body dissatisfaction among individuals with type 1 diabetes fail to improve diabetes management and glycemic control (e.g., HbA1c) [16-18], suggesting the presence of other factors that influence the decision to withhold insulin on a particular day, or for a particular meal or snack.…”