Abstract
Background‘Diabulimia’ is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research.MethodsForty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis.ResultsThe average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction.ConclusionsOverall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider.
Highlights
Diabulimia is an eating disorder experienced by people with Type 1 diabetes mellitus (T1DM)
Participants initially consisted of 55 individuals who stated they had T1DM and a history of insulin misuse for the purpose of weight loss
Data screening The normal distribution of the Eating Disorder Examination Questionnaire (EDE-Q) data was examined with analysis of the skewness and kurtosis values for each subscale and global scores
Summary
Diabulimia is an eating disorder experienced by people with Type 1 diabetes mellitus (T1DM). It is characterised by the deliberate restriction of insulin, resulting in weight loss [1]. In 2017, the guidelines for the treatment of eating disorders by The National Institute for Health and Care Excellence (NICE) included a section on diabetes for the first time [5]. The term ‘Diabulimia’ was not recognised, guidance on how best to treat those who restrict insulin was included. The inclusion of these new guidelines demonstrates that those with T1DM and an eating disorder, insulin omission, pose a unique problem [6]
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