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

Abstract

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.

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in adult men with Type 1 diabetes mellitus

“…The key disordered eating symptom of the use of insulin omission to influence shape and weight was discussed both by the women we interviewed previously 13 and men who participated in this study. This corroborates findings from a scoping review which showed that across 56 articles, up to three quarters of both men and women have used insulin omission to influence their shape and weight 20 . It was interesting to note that while several men discussed the use of insulin omission as a behaviour designed to influence their weight and shape, we did not find that there was a higher mean Hba1c in those reporting disordered eating than those who did not engage in disordered eating.…”

“…This corroborates findings from a scoping review which showed that across 56 articles, up to three quarters of both men and women have used insulin omission to influence their shape and weight. 20 It was interesting to note that while several men discussed the use of insulin omission as a behaviour designed to influence their weight and shape, we did not find that there was a higher mean Hba1c in those reporting disordered eating than those who did not engage in disordered eating. As we have found in women with Type 1 diabetes and disordered eating, there are many ways in which the disordered eating can manifest 13 and this was a heterogeneous group with men reporting a range of behaviours, not limited to but including insulin restriction or omission, which may explain why we did not identify hyperglycaemia.…”