Abstract
Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.
Highlights
Type 1 diabetes (T1D) is a condition which affects approximately 400,000 people in the United Kingdom alone, including 30,000 children (Diabetes UK, 2016)
After reviewing the available literature relating to diabulimia, Insulin omission (IO) and T1D, we identified the following factors as posing the most significant risk to the development of IO-related behaviour: gender, the presence of anxiety and depression and weight concern and body dissatisfaction
Gender is well referenced as a significant factor in the development of several mental health conditions, with women and young girls being more susceptible to developing conditions including depression, anxiety and eating disorders
Summary
Type 1 diabetes (T1D) is a condition which affects approximately 400,000 people in the United Kingdom alone, including 30,000 children (Diabetes UK, 2016). As a consequence of hyperglycaemia, profound changes in energy metabolism occur, resulting in a catabolic condition with “severe depletion of both energy stores and protein mass” (Hebert & Nair, 2010). This insulin-deficient state leads to weight loss, as the body is forced to breakdown fatty acids to maintain normal muscle and other tissue functions. Insulin omission (IO) is a behaviour engaged in by people with T1D Research suggests that it may be as a method of weight loss (Polonsky et al, 1994). A number of the risk factors of IO explored in this review are seen as having greater prevalence among young people, suggesting that children and young people who have T1D, alongside one or more of these risk factors, will be at significant risk of engaging in IO as a weight loss method
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