This article is more than 5 years old. Information may no longer be current.
Negative feelings often precede insulin restriction in type 1 diabetes eating disorders
Click Here to Manage Email Alerts
Addressing feelings of heightened anxiety and guilt could effectively decrease the restriction of insulin as part of eating disorder symptomatology in adults with type 1 diabetes, according to recent study findings published in Diabetes Care.
In the study, Rhonda M. Merwin, PhD, of Duke University Medical Center, and colleagues evaluated 83 adults with type 1 diabetes to determine predictors of insulin restriction in the environment that could reveal new treatment directions. Eligible participants were aged 18 to 65 years and had a score of 20 or higher on the Diabetes Eating Problems Survey–Revised (DEPS-R), which is a diabetes-specific parameter of eating disorder symptoms, including maladaptive insulin restriction for weight control.
Blood samples were taken to measure HbA1c, and participants also were interviewed by a clinician regarding eating disorder symptoms. Participants were fitted with continuous glucose monitoring sensors and took part in 3 days of ecological momentary assessment, in which they reported via cellular phone their emotions, eating habits and insulin dosing throughout the course of the day.
The researchers found that among the participants, insulin restriction varied, with some participants reporting no incidence of restricting insulin during the 3 days of the study, and others reporting restricting bolus insulin 100% of the time (mean, 14.82%). There was no significant correlation between the regularity of insulin restriction and insulin pump use or other demographic data.
A total of 299 eating episodes including affect reports were identified, and 70 indicated insulin restriction. Negative affect before a meal was found to be predictive of insulin restriction, suggesting a between-person (P < .01) and within-person effect (P < .05). Therefore, a mean negative-affect rating 1 unit higher than the mean equaled a 6.77 times greater likelihood of insulin restriction.
Additionally, analyses controlling for an individual’s average level revealed that every 1-point increase in preprandial negative affect more than doubled the risk for insulin restriction for that eating episode. The likelihood of insulin restriction also was higher when individuals failed to heed a personal dietary rule, such as “no desserts.”
According to the researchers, this study expands on previous research identifying associations between emotional problems and poor diabetes management by showing that temporary increases in negative affect often precede insulin restriction.
“The current study specifically identified heightened anxiety/nervousness and guilt/disgust with self before eating as precipitants to insulin restriction,” the researchers wrote. “This suggests that helping individuals respond effectively to these emotions might decrease insulin restriction and possibly improve metabolic control.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts