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Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology.

AbstractOBJECTIVE:
Individuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions.
RESEARCH DESIGN AND METHODS:
Eighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed 3 days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction.
RESULTS:
Individuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual's typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., "no desserts").
CONCLUSIONS:
Results suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.
AuthorsRhonda M Merwin, Natalia O Dmitrieva, Lisa K Honeycutt, Ashley A Moskovich, James D Lane, Nancy L Zucker, Richard S Surwit, Mark Feinglos, Jennifer Kuo
JournalDiabetes care (Diabetes Care) Vol. 38 Issue 11 Pg. 2025-32 (Nov 2015) ISSN: 1935-5548 [Electronic] United States
PMID26384389 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Copyright© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Chemical References
  • Insulin
Topics
  • Adolescent
  • Adult
  • Aged
  • Anxiety (diagnosis, psychology)
  • Body Weight (physiology)
  • Diabetes Mellitus, Type 1 (complications, drug therapy, mortality)
  • Dose-Response Relationship, Drug
  • Eating
  • Emotions
  • Feeding and Eating Disorders (complications, psychology)
  • Female
  • Humans
  • Insulin (administration & dosage)
  • Male
  • Medication Adherence (psychology)
  • Middle Aged
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • Weight Loss
  • Young Adult

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