click here


Restrict and Omit Insulin for Weight Control: Evidence-based guidance for healthcare professionals


Abstract

Purpose

Evidence-based guidance is needed to inform care for individuals with Type 1 Diabetes Mellitus who deliberately restrict and omit insulin for weight control. Consensus on the best treatment approach for these individuals is currently lacking, and standard eating disorder treatment protocols are ineffective. This article focuses on how healthcare professionals can provide meaningful care to this population.

Methods

Qualitative research studies were synthesised in a meta-aggregative meta-synthesis. We identified key themes related to individuals’ understanding and experience, physical and psychological impacts, support and treatment-related needs and experiences. These themes guided the development of implications for practice.

Results

Individuals engaging in insulin misuse wanted healthcare professionals to demonstrate more empathy, validate their experiences, have increased knowledge about their illness and develop more specialist pathways.

Conclusions

The findings have widespread interdisciplinary implications for health professionals working with individuals with Type 1 Diabetes Mellitus. Evidence-informed implications for practice are provided and may provide useful guidance concerning the prevention and treatment of this unique behaviour.

Keywords

To read this article in full you will need to make a payment

Purchase one-time access:

Academic and PersonalCorporate R&D Professionals
One-time access price info

Subscribe:

Subscribe to Diabetes Research and Clinical Practice
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Institutional Access: Sign in to ScienceDirect

References

    • Davidson J.
    Diabulimia: how eating disorders can affect adolescents with diabetes.
    Nursing Standard. 2014; 2944-49
    • Doyle E.A.
    • Quinn S.M.
    • Ambrosino J.M.
    • Weyman K.
    • Tamborlane W.V.
    • Jastreboff A.M.
    Disordered eating behaviors in emerging adults with type 1 diabetes: a common problem for both men and women.
    Journal of Pediatric Health Care. 2017; 31327-333
    • Hasken J.
    • Kresl L.
    • Nydegger T.
    • Temme M.
    Diabulimia and the role of school health personnel.
    Journal of School Health. 2010; 80465-469
    • Affenito S.G.
    • Adams C.H.
    Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered?.
    Nutrition Reviews. 2001; 59179
    • Mathieu J.
    What is diabulimia?.
    Journal of the Academy of Nutrition and Dietetics. 2008; 108769-770
    • Jones J.M.
    • Lawson M.L.
    • Daneman D.
    • Olmsted M.P.
    • Rodin G.
    Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study.
    BMJ. 2000; 3201563-1566
    • Takii M.
    • Uchigata Y.
    • Tokunaga S.
    • Amemiya N.
    • Kinukawa N.
    • Nozaki T.
    • et al.
    The duration of severe insulin omission is the factor most closely associated with the microvascular complications of type 1 diabetic females with clinical eating disorders.
    International Journal of Eating Disorders. 2008; 41259-264
    • Goebel-Fabbri A.E.
    • Fikkan J.
    • Franko D.L.
    • Pearson K.
    • Anderson B.J.
    • Weinger K.
    Insulin restriction and associated morbidity and mortality in women with type 1 diabetes.
    Diabetes Care. 2008; 31415-419
    • De Paoli T.
    • Rogers P.J.
    Disordered eating and insulin restriction in type 1 diabetes: A systematic review and testable model.
    Eating Disorders. 2018; 26343-360
    • Banting R.
    • Randle-Phillips C.
    A systematic review of psychological interventions for comorbid type 1 diabetes mellitus and eating disorders.
    Diabetes Management. 2018; 81-8
    • Clery P.
    • Stahl D.
    • Ismail K.
    • Treasure J.
    • Kan C.
    Systematic review and meta- analysis of the efficacy of interventions for people with Type 1 diabetes mellitus and disordered eating.
    Diabetic Medicine. 2017; 341667-1675
    • Colton P.A.
    • Olmsted M.P.
    • Daneman D.
    • Farquhar J.C.
    • Wong H.
    • Muskat S.
    • et al.
    Eating disorders in girls and women with type 1 diabetes: a longitudinal study of prevalence, onset, remission, and recurrence.
    Diabetes Care. 2015; 381212-1217
    • Custal N.
    • Arcelus J.
    • Agüera Z.
    • Bove F.I.
    • Wales J.
    • Granero R.
    • et al.
    Treatment outcome of patients with comorbid type 1 diabetes and eating disorders.
    BMC Psychiatry. 2014; 14https://doi.org/10.1186/1471-244X-14-140
    • Pinhas-Hamiel O.
    • Hamiel U.
    • Levy-Shraga Y.
    Eating disorders in adolescents with type 1 diabetes: challenges in diagnosis and treatment.
    World Journal of Diabetes. 2015; 6517
    • Tierney S.
    • Deaton C.
    • Whitehead J.
    Caring for people with type 1 diabetes mellitus engaging in disturbed eating or weight control: a qualitative study of practitioners’ attitudes and practices.
    Journal of Clinical Nursing. 2009; 18384-390
    • Macdonald P.
    • Kan C.
    • Stadler M.
    • De Bernier G.L.
    • Hadjimichalis A.
    • Le Coguic A.-S.
    • et al.
    Eating disorders in people with Type 1 diabetes: experiential perspectives of both clients and healthcare professionals.
    Diabetic Medicine. 2018; 35223-231
    • Goddard M.G.
    • Oxlad M.
    Insulin Restriction or Omission in Type 1 Diabetes Mellitus: A Meta-synthesis of Individuals’ Experiences of Diabulimia.
    Health Psychology Review. 2022; 1-41
    • Liberati A.
    • Altman D.G.
    • Tetzlaff J.
    • Mulrow C.
    • Gøtzsche P.C.
    • Ioannidis J.P.A.
    • et al.
    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
    Journal of Clinical Epidemiology. 2009; 62e1-e34
    • Tong A.
    • Flemming K.
    • McInnes E.
    • Oliver S.
    • Craig J.
    Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ.
    BMC Medical Research Methodology. 2012; 121-8
  1. Kmet LM, Cook LS, Lee RC. Standard quality assessment criteria for evaluating primary research papers from a variety of fields. 2004. Edmonton: Alberta Heritage Foundation for Medical Research (AHFMR).

    • Pursey K.M.
    • Hart M.
    • Jenkins L.
    • McEvoy M.
    • Smart C.E.
    Screening and identification of disordered eating in people with type 1 diabetes: a systematic review.
    Journal of Diabetes and its Complications. 2020; 34107522https://doi.org/10.1016/j.jdiacomp.2020.107522
    • Markowitz J.T.
    • Butler D.A.
    • Volkening L.K.
    • Antisdel J.E.
    • Anderson B.J.
    • Laffel L.M.
    Brief screening tool for disordered eating in diabetes: internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes.
    Diabetes Care. 2010; 33495-500
  2. National Institute for Health and Care Excellence (Great Britain). Type 1 diabetes in adults: diagnosis and management. National Institute for Health and Care Excellence (NICE); 2015, updated 2021.

  3. National Institute for Health and Care Excellence (Great Britain). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. National Institute for Health and Care Excellence (NICE); 2015, updated 2020.

    • Peterson M.
    • Ellenberg D.
    • Crossan S.
    Body-image perceptions: reliability of a BMI-based silhouette matching test.
    American Journal of Health Behavior. 2003; 27355-363
    • Mendelson B.K.
    • Mendelson M.J.
    • White D.R.
    Body-esteem scale for adolescents and adults.
    Journal of Personality Assessment. 2001; 7690-106
    • Fairburn C.G.
    • Beglin S.J.
    Assessment of eating disorders: Interview or self-report questionnaire?.
    International Journal of Eating Disorders. 1994; 16363-370
  4. National Institute for Health and Care Excellence (Great Britain). Eating disorders: Recognition and treatment. National Institute for Health and Care Excellence (NICE); 2017.

    • Young V.
    • Eiser C.
    • Johnson B.
    • Brierley S.
    • Epton T.
    • Elliott J.
    • et al.
    Eating problems in adolescents with Type 1 diabetes: a systematic review with meta- analysis.
    Diabetic Medicine. 2013; 30189-198
    • Takii M.
    • Uchigata Y.
    • Kishimoto J.
    • Morita C.
    • Hata T.
    • Nozaki T.
    • et al.
    The relationship between the age of onset of type 1 diabetes and the subsequent development of a severe eating disorder by female patients.
    Pediatric diabetes. 2011; 12396-401
    • Baechle C.
    • Castillo K.
    • Straßburger K.
    • Stahl-Pehe A.
    • Meissner T.
    • Holl R.W.
    • et al.
    Is disordered eating behavior more prevalent in adolescents with early-onset type 1 diabetes than in their representative peers?.
    International Journal of Eating Disorders. 2014; 47342-352
    • Schechter D.E.
    • Francis C.M.
    A life history approach to understanding youth time preference.
    Human Nature. 2010; 21140-164
  5. Hillege SP. The Impact of Type 1 Diabetes on the Self of Adolescents and Young Adults. Unpublished Doctoral Thesis. Sydney: University of Western Sydney. 2005.

    • Colton P.A.
    • Olmsted M.P.
    • Daneman D.
    • Rodin G.M.
    Depression, disturbed eating behavior, and metabolic control in teenage girls with type 1 diabetes.
    Pediatric Diabetes. 2013; 14372-376
    • Trief P.M.
    • Xing D.
    • Foster N.C.
    • Maahs D.M.
    • Kittelsrud J.M.
    • Olson B.A.
    • et al.
    Depression in adults in the T1D Exchange Clinic Registry.
    Diabetes Care. 2014; 371563-1572
    • Caccavale L.J.
    • Nansel T.R.
    • Quick V.
    • Lipsky L.M.
    • Laffel L.M.
    • Mehta S.N.
    Associations of disordered eating behavior with the family diabetes environment in adolescents with type 1 diabetes.
    Journal of Developmental and Behavioral Pediatrics: JDBP. 2015; 368
    • Neumark-Sztainer D.
    • Patterson J.
    • Mellin A.
    • Ackard D.M.
    • Utter J.
    • Story M.
    • et al.
    Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: associations with sociodemographics, weight concerns, familial factors, and metabolic outcomes.
    Diabetes Care. 2002; 251289-1296
    • Meno C.A.
    • Hannum J.W.
    • Espelage D.E.
    • Low K.S.D.
    Familial and individual variables as predictors of dieting concerns and binge eating in college females.
    Eating Behaviors. 2008; 991-101
    • Shomaker L.B.
    • Furman W.
    Interpersonal influences on late adolescent girls' and boys' disordered eating.
    Eating Behaviors. 2009; 1097-106
    • Hilliard M.E.
    • Powell P.W.
    • Anderson B.J.
    Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families.
    American Psychologist. 2016; 71590-601
    • Saylor J.
    • Lee S.
    • Ness M.
    • Ambrosino J.M.
    • Ike E.
    • Ziegler M.
    • et al.
    Positive health benefits of peer support and connections for college students with type 1 diabetes mellitus.
    The Diabetes Educator. 2018; 44340-347
    • Alloway S.C.
    • Toth E.L.
    • McCargar L.J.
    Effectiveness of a group psychoeducation program for the treatment of subclinical disordered eating in women with type 1 diabetes.
    Canadian Journal of Dietetic Practice and Research. 2001; 62188
    • Olmsted M.P.
    • Daneman D.
    • Rydall A.C.
    • Lawson M.L.
    • Rodin G.
    The effects of psychoeducation on disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus.
    International Journal of Eating Disorders. 2002; 32230-239

Article Info

Publication History

Publication stage

In Press Journal Pre-Proof

Identification

DOI: https://doi.org/10.1016/j.diabres.2022.109783

Copyright

ScienceDirect

Access this article on ScienceDirect