The aim of this study was to systematically assess the association of insulinmanipulation (intentional under and/or overdosing of insulin), psychiatric comorbidity and diabetes complications.
Two diagnostic interviews (DiabetesSelfManagementPatientInterview and Children'sDiagnosticInterview for Psychiatric Disorders) were conducted with 241 patients (age 1022) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records.
Psychiatric comorbidity was found in nearly half of the patients with insulinmanipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulinmanipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of nonadherence to insulin therapy. Insulinmanipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulinmanipulation.
This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under and/or overdosing.
Internalizing psychiatric disorders were associated with insulinmanipulation, especially in female patients and insulinmanipulation was associated with deteriorated metabolic control and diabetes complications.