Disinhibited Eating and Weight-related Insulin Mismanagement Among Individuals with Type 1 Diabetes

Overview

Journal Appetite

Specialties Nutritional Sciences
Social Sciences

Date 2014 Jun 3

PMID 24882448

Citations 14

Authors

Rhonda M Merwin

Ashley A Moskovich

Natalia O Dmitrieva

Carl F Pieper

Lisa K Honeycutt

Nancy L Zucker

Richard S Surwit

Lori Buhi

Affiliations

Soon will be listed here.

Abstract

Objective: Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c).

Methods: Two-hundred and seventy-six individuals with type 1 diabetes completed an online survey of eating behaviors, insulin dosing and most recent HbA1c. We used structural equation modeling to test the hypothesis that disinhibited eating when blood sugar is thought to be low predicts weight-related insulin mismanagement, and this, in turn, predicts higher HbA1c.

Results: The majority of participants endorsed some degree of disinhibition when they think their blood glucose is low (e.g., eating foods they do not typically allow) and corresponding negative affect (e.g., guilt/shame). The frequency of disinhibited eating was positively associated with weight-related insulin mismanagement. Controlling for age, sex, education, and insulin pump use, the model explained 31.3% of the variance in weight-related insulin mismanagement and 16.8% of the variance in HbA1c.

Conclusion: Addressing antecedents to disinhibited eating that are unique to type 1 diabetes (e.g., perceived BG level) and associated guilt or shame may reduce weight-related insulin omission.

Citing Articles

Subtypes of Insulin Restriction in Diabetes Management: A Systematic Review.

Beam A, Wiebe D Curr Diab Rep. 2025; 25(1):20.

PMID: 39869135 DOI: 10.1007/s11892-025-01577-3.

The impact of emotion regulation strategies on disordered eating behavior in children and adolescents with type 1 diabetes: a cross-sectional study.

Yang X, Jiang H, Lin M, Yu S, Wu J Front Pediatr. 2024; 12:1400997.

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Profiles of disordered eating behaviour in type 1 diabetes using the DEPS-R and behaviour and glycaemic outcomes in a real-life setting.

Merwin R, Dmitrieva N, Moskovich A, Warnick J, Goebel-Fabbri A, Topor L Diabet Med. 2024; 41(6):e15314.

PMID: 38450859 PMC: 11114251. DOI: 10.1111/dme.15314.

Eating behaviors and estimated body fat percentage among adolescents with type 1 diabetes.

Tran T, Igudesman D, Burger K, Crandell J, Maahs D, Seid M Diabetes Res Clin Pract. 2023; 207:111070.

PMID: 38142747 PMC: 10922665. DOI: 10.1016/j.diabres.2023.111070.

Validation of the traditional Chinese version of the diabetes eating problem survey-revised and study of the prevalence of disordered eating patterns in Chinese patients with type 1 DM.

Lok C, Wong M, Yip K, Ching W, Choi E BMC Psychiatry. 2023; 23(1):382.

PMID: 37259043 PMC: 10230489. DOI: 10.1186/s12888-023-04744-6.

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