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06-11-2019 | Adolescents | ADA 2019 | News

Insulin omission for weight purposes linked to increased depression in youth

medwireNews: Young people who deliberately omit insulin to either lose weight or prevent weight gain report worse psychosocial functioning, particularly depressive symptoms, than those who have never skipped a dose for this reason, study data show.

Jaclyn Papadakis (Ann & Robert H Lurie Children’s Hospital of Chicago, Illinois, USA) reported at the 79th ADA Scientific Sessions in San Francisco, California, USA, that 11% of 54 adolescents (mean age 14.7 years) with type 1 diabetes included in her study had intentionally omitted insulin for weight control purposes at least once in the previous year.

Padadakis said that this rate was “too high”, with one participant doing so on a daily basis to avoid gaining weight.

Analysis of self-reported psychosocial outcomes, assessed using a psychosocial screening battery that included the PROMIS® depression and anxiety scales, the Problem Areas in Diabetes measure, and the Diabetes Family Conflict Scale, revealed that “across the board, kids who are intentionally omitting insulin are reporting worse psychosocial functioning.”

Compared with participants who did not omit insulin for weight purposes, those who did were significantly more likely to report depressive symptoms (57.75 vs 49.28%) and have clinically elevated depression (67 vs 8%).

They also reported more anxiety symptoms, more diabetes distress, and more diabetes-related family conflict.

There were no differences between the two groups, however, in mental health history or in any parent-reported psychosocial outcomes.

There were also no significant differences between those who omitted insulin and those who did not in any sociodemographic or diabetes-related variables. These included age, gender, household income, diabetes duration, glycated hemoglobin level, and insulin delivery method among others.

Padadakis pointed out that the cross-sectional nature of the data means “we are not able to make any causal statements here. We really need additional longitudinal research to be able to understand the direction [of the association].”

She added: “Fortunately, we are continuing our psychosocial screening here so pretty soon we’ll be able to have that data to look at that.”

Papadakis also noted that “longitudinal studies have found that engaging in this intentional omission of insulin is associated with diabetes-related medical complications in the long-term as well as a three-fold higher risk of mortality, so this is clearly a very serious issue.”

“Psychosocial screening during routine diabetes visits can identify youth in need of behavioral health interventions, but what’s really important then is once they are identified we need to make sure that we have effective interventions that we can then refer them to,” she continued.

Indeed, she commented that a recent metanalysis showed that current interventions specifically targeting intentional insulin omission lead to little or no improvements in this behavior “so more interventions targeting this are clearly needed.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

79th ADA Scientific Sessions; San Francisco, California, USA: 7–11 June 2019

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