Insulin restriction and associated morbidity and mortality in women with type 1 diabetes
Abstract
OBJECTIVE—To determine whether insulin restriction increases morbidity and mortality in women with type 1 diabetes. RESEARCH DESIGN AND METHODS—This is an 11-year follow-up study of women with type 1 diabetes. A total of 234 women (60% of the original cohort) participated in the follow-up. Mean age was 45 years and mean diabetes duration was 28 years at follow-up. Mean BMI was 25 kg/m2 and mean A1C was 7.9%. Measures of diabetes self-care behaviors, diabetes-specific distress, fear of hypoglycemia, psychological distress, and eating disorder symptoms were administered at baseline. At follow-up, mortality data were collected through state and national databases. Follow-up data regarding diabetes complications were gathered by self-report. RESULTS—Seventy-one women (30%) reported insulin restriction at baseline. Twenty-six women died during follow-up. Based on multivariate Cox regression analysis, insulin restriction conveyed a threefold increased risk of mortality after controlling for baseline age, BMI, and A1C. Mean age of death was younger for insulin restrictors (45 vs. 58 years, P < 0.01). Insulin restrictors reported higher rates of nephropathy and foot problems at follow-up. Deceased women had reported more frequent insulin restriction (P < 0.05) and reported more eating disorder symptoms (P < 0.05) at baseline than their living counterparts. CONCLUSIONS—Our data demonstrate that insulin restriction is associated with increased rates of diabetes complications and increased mortality risk. Mortality associated with insulin restriction appeared to occur in the context of eating disorder symptoms, rather than other psychological distress. We propose a screening question appropriate for routine diabetes care to improve detection of this problem.
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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 [81]
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 [81]
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 [403]
People with type 1 diabetes and disordered eating with insulin omission have a 3-fold mortality.
“This is best demonstrated with the 3-fold mortality of people with type 1 diabetes and disordered eating with insulin omission [73,74].”
From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [73]
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Psychological Co-morbidities of Physical Illness
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A review of risk factors associated with insulin omission for weight loss in type 1 diabetes
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Metabolic Control and Illness Perceptions in Adolescents with Type 1 Diabetes
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Self-citationTest of the modified dual pathway model of eating disorders in individuals with type 1 diabetes
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- Authors
- Goebel-Fabbri, A. E., Fikkan, J., Franko, D. L., Pearson, K., Anderson, B. J., & Weinger, K.
- Affiliations
- Joslin Diabetes Center (US)
- Northeastern University (US)
- Harvard University (US)
- Baylor College of Medicine (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2008-03-01
- Volume
- 31
- Issue
- 3
- Pages
- 415-419
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2131424821
- Cited by
- 352
- References
- 25
- Citations by year
- 2026: 19 · 2025: 17 · 2024: 22 · 2023: 30 · 2022: 27 · 2021: 28 · 2020: 27 · 2019: 28 · 2018: 20 · 2017: 15 · 2016: 16 · 2015: 23 · 2014: 12 · 2013: 17 · 2012: 8
- FWCI
- 10.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Joslin Diabetes Center
- National Institute of Diabetes and Digestive and Kidney Diseases (P30-DK36836, P30DK036836)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- type 1 diabetes, women, mortality, eating disorder symptoms, diabetes complications, kidney disease, diabetic foot, psychological distress, fear of hypoglycemia, diabetes self-care, screening
- MeSH terms
- Adult, Feeding and Eating Disorders, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Insulin, Middle Aged, Morbidity, Self Care, Survival Rate, Multivariate Analysis, Proportional Hazards Models, Diabetes Complications, Kaplan-Meier Estimate
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