INSULIN OMISSION IN WOMEN WITH IDDM

OBJECTIVE- To describe the extent of intentional insulin omission in a n outpatient population of women with insulin-dependent diabetes melli tus (IDDM) and examine its relationship to disordered eating, attitude s toward diabetes, other psychosocial factors, long-term complications , and glycemic control. RESEARCH DESIGN AND METHODS- Before their rout inely scheduled clinic appointments, female IDDM patients who were 13- 60 years of age completed a self-report survey (final n = 341). The su rvey included standardized questionnaires assessing disordered eating altitudes and behaviors, psychological functioning (general distress, diabetes-specific distress, and hypoglycemic fear), attitudes toward d iabetes, and self-care behaviors. All subjects were assessed for glyco sylated hemoglobin within 30 days of survey completion. Long-term comp lications were determined through chart review. RESULTS- Approximately 31% of the subject sample, representing women of all ages, reported i ntentional insulin omission, but only 8.8% reported frequent omission. Compared with non-emitters, emitters reported more disordered eating, greater psychological distress (general and diabetes-specific), more hypoglycemic fear, poorer regimen adherence, and greater fears concern ing improved diabetes management (which may lead to weight gain). Omit ters evidenced poorer glycemic control, more diabetes-related hospital izations, and higher rates of retinopathy and neuropathy. Multivariate examination revealed only two variables that independently predicted omission: diabetes-specific distress and fear of improved glycemic con trol (''because I will gain weight''). Of the omitters, approximately half reported omitting insulin for weight-management purposes (weight- related omitters). These subjects evidenced significantly greater psyc hological distress, poorer regimen adherence (including more frequent omission), poorer glycemic control, and higher rates of complications than did non-weight-related emitters as well as non-emitters. Non-weig ht-related emitters tended to fall between weight-related omitters and non-emitters on most measures of psychological functioning, adherence , and CONCLUSIONS- These findings suggest that insulin omission is com mon, that it is not limited to younger women, and that the medical con sequences of omission, especially frequent omission, may be severe. Al though a strong association between omission and disordered eating was observed, these data suggest that this link may be complicated by imp ortant diabetes-specific factors. Patients preoccupied with eating and weight concerns may also become emotionally overwhelmed by diabetes a nd/or fearful of normoglycemia (and the associated weight related cons equences), thus reinforcing the desire to omit insulin and maintain el evated blood glucose levels.