Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus
Abstract
Objective: Intentional insulin omission is a unique inappropriate compensatory behavior that occurs in patients with type 1 diabetes mellitus, mostly in females, who omit or restrict their required insulin doses in order to lose weight. Diagnosis of this underlying disorder is difficult. We aimed to use clinical and laboratory criteria to create an algorithm to assist in the detection of intentional insulin omission. Method: The distribution of HbA1c levels from 287 (181 females) patients with type 1 diabetes were used as reference. Data from 26 patients with type 1 diabetes and intentional insulin omission were analysed. The Weka (Waikato Environment for Knowledge Analysis) machine learning software, decision tree classifier with 10‐fold cross validation was used to developed prediction models. Model performance was assessed by cross‐validation in a further 43 patients. Results: Adolescents with intentional insulin omission were discriminated by: female sex, HbA1c>9.2%, more than 20% of HbA1c measurements above the 90th percentile, the mean of 3 highest delta HbA1c z‐scores>1.28, current age and age at diagnosis. The models developed showed good discrimination (sensitivity and specificity 0.88 and 0.74, respectively). The external test dataset revealed good performance of the model with a sensitivity and specificity of 1.00 and 0.97, respectively. Discussion: Using data mining methods we developed a clinical prediction model to determine an individual's probability of intentionally omitting insulin. This model provides a decision support system for the detection of intentional insulin omission for weight loss in adolescent females with type 1 diabetes mellitus. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:819–825)
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For people with type 1 diabetes, insulin omission to cause glycosuria for weight loss is the most commonly reported disordered eating behavior.
“For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior (80,81),”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [80]
For people with type 2 diabetes, bingeing is the most commonly reported disordered eating behavior.
“and in people with type 2 diabetes, bingeing (excessive food intake with an accompanying sense of loss of control) is most commonly reported.”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [80]
For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior; for people with type 2 diabetes, bingeing is most commonly reported.
“For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior (402,403); in people with type 2 diabetes, bingeing (excessive food intake with an accompanying sense of loss of control) is most commonly reported.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [402]
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- Authors
- Pinhas‐Hamiel, O., Hamiel, U., Greenfield, Y., Boyko, V., Graph‐Barel, C., Rachmiel, M., Lerner‐Geva, L., & Reichman, B.
- Affiliations
- Tel Aviv University (IL)
- Sheba Medical Center (IL)
- The Women and Children's Health Research Unit, Gertner Institute Tel Hashomer, Ramat‐Gan Israel
- Maccabi Healthcare Services (IL)
- Assaf Harofeh Medical Center (IL)
- Corresponding author
- Pinhas‐Hamiel, Orit
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2013-05-15
- Volume
- 46
- Issue
- 8
- Pages
- 819-825
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W1599308405
- Cited by
- 44
- References
- 33
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 2 · 2015: 2 · 2014: 3
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, adolescent girls, weight loss, HbA1c, glycemic variability, decision tree classification, prediction model, clinical decision support, eating disorder comorbidity, compensatory behavior
- MeSH terms
- Adolescent, Adult, Age Factors, Feeding and Eating Disorders, Child, Child, Preschool, Decision Trees, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Insulin, Male, Patient Compliance, Sex Factors, Weight Loss, Case-Control Studies, Intention, Young Adult
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