Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria

Abstract

Background/Objective The aim of this study was to systematically assess the association of insulin‐manipulation (intentional under‐ and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. Methods Two diagnostic interviews (Diabetes‐Self‐Management‐Patient‐Interview and Children's‐Diagnostic‐Interview for Psychiatric Disorders) were conducted with 241 patients (age 10‐22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. Results Psychiatric comorbidity was found in nearly half of the patients with insulin‐manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin‐manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non‐adherence to insulin therapy. Insulin‐manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin‐manipulation. Conclusions This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under‐ and/or overdosing. Internalizing psychiatric disorders were associated with insulin‐manipulation, especially in female patients and insulin‐manipulation was associated with deteriorated metabolic control and diabetes complications.

Pharmacoadherence: An Opportunity for Digital Health to Inform the Third Dimension of Pharmacotherapy for Diabetes

“…24 Among a cohort of children that included both insulin dose manipulators and insulin users, psychiatric comorbidity was found in 46.3% compared to 17.5% of patients, respectively, and the former group compared to the latter group had higher HbA 1c levels by an average of 0.89%. 25 For people with diabetes prescribed oral agents, the traditional measures of success are HbA 1c , blood pressure, and/or levels of cholesterol and other lipids. These variables are rarely associated with symptoms and are often dependent on a third-party professional for providing the numbers.…”

“…24 Among a cohort of children that included both insulin dose manipulators and insulin users, psychiatric comorbidity was found in 46.3% compared to 17.5% of patients, respectively, and the former group compared to the latter group had higher HbA 1c levels by an average of 0.89%. 25…”

Gestörtes Essverhalten und Essstörungen bei Menschen mit Diabetes mellitus

“…Sowohl auffälliges Essverhalten als auch klinische Essstörungen gehen mit psychischen Komorbiditäten, z. B. Depressionen, Angststörungen, Zwangserkrankungen, Substanzmissbrauch oder Persönlichkeitsstörungen einher [1][2][3].…”

Prevalence and course of mood and anxiety disorders, and correlates of symptom severity in adolescents with type 1 diabetes: Results from diabetes LEAP

“…4 The few studies that used a diagnostic interview (presented in Table 1), the gold standard in assessing the presence of psychiatric disorders, had a small sample size, [5][6][7][8] were conducted over 20 years ago, 5,6 or failed to report adolescent specific rates. 6,[8][9][10] As adolescents are developmentally distinct from other age groups, adolescent-specific estimates are needed. Furthermore, current and previous disorders should be considered simultaneously to better understand the underlying vulnerability and course of these disorders.…”