A review of risk factors associated with insulin omission for weight loss in type 1 diabetes

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.

Diabulimia: una condición frecuentemente desapercibida

“…La prevalencia general de diabulimia se ha estimado aproximadamente del 30-40% en los pacientes con DM1, siendo más frecuente en las mujeres jóvenes 11,15 . No obstante, hay mucha variabilidad en la prevalencia dependiendo del lugar, de la población evaluada y del grupo etario, ya que algunos estudios han reportado que esta condición puede ser más frecuente en adolescentes, o bien en el rango de edad entre los 15 a los 30 años 13,16,17 . Sin embargo, puede presentarse en cualquier etapa de la vida.…”

“…La omisión o restricción del uso de insulina conlleva tres principales procesos: eliminación de glucosa por la orina, pérdida de agua por la diuresis osmótica y utilización del tejido adiposo y la masa muscular como sustratos energéticos, generando mayor producción de cuerpos cetónicos 21 . Por lo tanto, los signos y síntomas frecuentes en la diabulimia a corto plazo incluyen: sed, poliuria, infecciones en vías urinarias, visión borrosa, fatiga y déficit cognitivo manifestado como falta de concentración 16 .…”

Are the Effects of Malnutrition on the Gut Microbiota–Brain Axis the Core Pathologies of Anorexia Nervosa?

“…Some patients start to reduce their insulin dose in order to reduce their weight gain, causing subsequent weight loss. This behavior increases the risk of developing AN [ 36 ]. Both psychiatric and somatic diseases can therefore predispose on to and trigger AN.…”

Type 1 diabetes youth with disordered eating: Is there a disproportionate impact on ethnic minorities and indigenous peoples?

“…Which adolescents with T1D should be screened for DEB/ED? As is true for the general population, female sex, higher body mass index (BMI) and comorbid mental health conditions such as depression, are risk factors associated with the development of DEB/ED in adolescents with T1D 8,10,17 . However, it is important to emphasise that all adolescents with T1D are at risk of DEB/ED and should be screened.…”

“…As is true for the general population, female sex, higher body mass index (BMI) and comorbid mental health conditions such as depression, are risk factors associated with the development of DEB/ED in adolescents with T1D. 8,10,17 However, it is important to emphasise that all adolescents with T1D are at risk of DEB/ED and should be screened. Health-care professionals should bear in mind that DEB/ED in the T1D population can present as glycaemic instability which may display itself through higher HbA1c levels, active restriction or omission of insulin and recurrent presentations to hospital with diabetic ketoacidosis.…”