Insulin restriction or omission in Type 1 Diabetes Mellitus: a meta-synthesis of individuals’ experiences of diabulimia

Goddard, Georgia; Oxlad, Melissa

doi:10.1080/17437199.2021.2025133

Cited by 5 publications

(3 citation statements)

References 73 publications

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“…While current evidence is limited, the driving motivators for insulin restriction and/ or omission for weight and/or shape control may be qualitatively different for males than females. Findings suggest that reasons beyond body dissatisfaction may drive the behaviour among males with T1DM, including a desire to improve fitness performance [11] or in response to negative affect and difficulty regulating emotion [66]. Both negative affect generally and negative diabetes-related affect have previously been associated with increased odds of restricting insulin [86].…”

Section: Main Findings and Implicationsmentioning

confidence: 91%

“…The DEPS-R [73] and other existing tools for measuring body dissatisfaction, body image concerns and disordered eating behaviours are also often female-centric and less geared towards concerns more commonly held by males [84]. Furthermore, there are often high levels of secrecy and shame around disordered eating behaviours and eating disorders including insulin misuse [11,27,[89][90][91], and individuals may be secretive about their engagement in disordered eating behaviours for fear of stigmatisation [92,93] or due to low motivation for change [94]. Against this backdrop, identifying insulin restriction and/or omission generally among people with T1DM is difficult; however, our results suggest that a self-report measure capturing insulin restriction and/or omission may facilitate more honest reporting by individuals and an increased willingness to disclose the behaviour.…”

Section: Main Findings and Implicationsmentioning

confidence: 99%

“…While a clear diagnostic term and diagnostic criteria are currently lacking [10], individuals deliberately restricting and/or omitting insulin for weight and/or shape control have adopted the term "diabulimia" to describe their behaviour and report a distinct 'diabulimic' identity separate from other eating disorder labels [11]. While it is important to explore and respect terminology of those with lived experience, controversy around the term 'diabulimia' exists as it is often used differently between studies creating confusion regarding its meaning.…”

Section: Introductionmentioning

confidence: 99%

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The misuse of insulin by males with Type 1 Diabetes Mellitus for weight and/or shape control: a systematic scoping review

Goddard

Oxlad

Turnbull

2022

J Diabetes Metab Disord

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Background Insulin restriction and/or omission in Type 1 Diabetes Mellitus (T1DM) is a risky disordered eating behaviour increasingly reported in the literature. Most existing literature has focused on females with T1DM. Previous research, however, suggests disordered eating behaviours are over-represented in males with T1DM versus males without T1DM. This systematic scoping review sought to summarise the existing literature to contribute to the development of an understanding of males’ misuse of insulin for weight and/or shape control. Methods A systematic scoping review methodology was used. We searched six electronic databases. Eligible articles were quantitative, qualitative, or mixed methods empirical studies with primary data on the restriction and/or omission of insulin for weight and/or shape control among males, written in English from database inception to December 2021. Results A final sample of 56 articles was included (48 quantitative, six qualitative and two mixed methods). Where it was reported to occur, estimates of the behaviour ranged from 5 to 75% in females and 1.4% to 76% in males. In 12 studies examining sex differences, only three reported higher prevalence in females. Understandings about the behavioural context of the behaviour were hampered by lack of qualitative research (n = 4 studies). Conclusion Despite common preconceptions, this disordered eating behaviour appears to occur similarly in males and females. The findings shed light on areas for future research, including aetiology in males and the need for longitudinal and qualitative research. Clinical recommendations include being alert to the possibility of this behaviour in males with Type 1 Diabetes Mellitus and the need for health professionals to use open-ended questions to explore current and past deliberate restriction and/or omission of insulin among their patients.

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Section: Main Findings and Implicationsmentioning

confidence: 91%