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

Increased bolus overrides and lower time in range: Insights into disordered eating revealed by insulin pump metrics and continuous glucose monitor data in Australian adolescents with type 1 diabetes

AIMS

To determine the prevalence of disordered eating behaviors (DEB) in a population of Australian adolescents with T1D and to investigate clinical parameters, insulin pump therapy (IPT) and continuous glucose monitor (CGM) data trends, and psychological attributes associated with DEB.

METHODS

50 participants (27 female, 23 male, average age 15.2 years, average duration of diabetes 6.2 years) were recruited. Diabetes Eating Problem Survey-Revised (DEPS-R) and Strengths and Difficulties Questionnaires were completed. Prevalence of disordered eating was reported, and associations with clinical parameters, insulin pump therapy (IPT) and continuous glucose monitor (CGM) metrics were assessed.

RESULTS

Twenty-four participants (48 %) had an elevated DEPS-R score. Participants with elevated DEPS-R were more likely to be female (75 % vs 31.6 %, p = 0.004), have a higher HbA1c (8.2 %/67 mmol/mol vs. 6.9 %/51 mmol/mol, p < 0.002) and BMI Z-score (+1.28 SD vs +0.76 SD, p = 0.040). They had lower time in range, 3.9-10 mmol/L (50.3 % vs. 63.8 %, p = 0.01) and higher mean glucose (10.0 mmol/L vs. 8.3 mmol/L, p = 0.005). Of the 60 % using IPT, participants with elevated DEPS-R had increased meal bolus overrides (7.9 % vs 3.8 %, p = 0.047). Reported difficulties on SDQ were higher in the elevated DEPS-R group (18.3 vs 10.5, p < 0.002).

CONCLUSIONS

DEB are common in Australian adolescents with T1D and associated with increased dysglycemia. Diabetes technology cannot be solely relied upon for detection of DEB and there remains a need for routine screening.

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

AIMS

This qualitative study aimed to develop the first cognitive behavioural (CBT) model outlining the development and maintenance of disordered eating in adult men living with Type 1 diabetes to improve on previous theoretical models of Type 1 diabetes and disordered eating and to draw comparisons to women with Type 1 diabetes and disordered eating.

METHODS

Twenty-seven men (n = 16 with Type 1 diabetes and disordered eating, n = 11 with Type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using thematic analysis and individual CBT formulations were developed for each participant to inform the model.

RESULTS

Men with Type 1 diabetes and disordered eating experience negative thoughts about food, insulin, weight/shape and diabetes itself, which cause negative emotions such as fear and vulnerability and difficulties with diabetes self care such as problems with hyper and hypoglycaemia and problems accessing structured education and technology result in men feeling more dissatisfied about their body weight/shape.

CONCLUSIONS

This CBT model of disordered eating in men with Type 1 diabetes can guide new interventions.

Health Professionals' Experiences Supporting People With Type 1 Diabetes Mellitus Who Deliberately Restrict and/or Omit Insulin for Weight, Shape, and/or Appearance: A Meta-synthesis

OBJECTIVES

It has been reported that health professionals currently lack the required empathy, understanding, and knowledge about the deliberate restriction and/or omission of insulin to influence weight and/or shape, which may impact the quality of care provided. We sought to synthesize existing qualitative research pertaining to health professionals' experiences supporting individuals within this unique population.

METHODS

We conducted a meta-synthesis using a meta-aggregative approach. We searched 5 electronic databases. Eligible articles were qualitative or mixed-methods empirical studies with primary data reporting health professionals' experiences supporting people with type 1 diabetes restricting and/or omitting insulin for weight and/or shape control, written in English, from database inception to March 2022.

RESULTS

A final sample of 4 primary studies were included. The analysis indicated that in the absence of standardized screening and diagnostic tools, health professionals found it challenging to decide when behaviour became clinically significant. Health professionals were also challenged by complex perceptions and behaviours relating to their illness management and features of broader health-care systems and organizational factors.

CONCLUSIONS

Our findings have widespread multidisciplinary implications for health professionals and the broader health-care systems in which they work. We provide evidence-based clinical recommendations and suggestions for vital future research.