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Titel
Association of insulin-manipulation and psychiatric disorders : A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria
Verfasser / VerfasserinWagner, Gudrun ; Berger, Gabriele ; Waldhoer, Thomas ; Barrientos, Irene ; Kunkel, Daniela ; Rami-Merhar, Birgit M. ; Schober, Edith ; Karwautz, Andreas
Erschienen in
Pediatric Diabetes, 2019, Jg. 20, H. 1, S. 127-136
ErschienenWiley-Blackwell, 2019
SpracheEnglisch
DokumenttypAufsatz in einer Zeitschrift
Schlagwörter (EN)adolescent / diabetes complications / medication adherence / mental disorders / psychology
URNurn:nbn:at:at-ubmuw:3-723 Persistent Identifier (URN)
DOI10.1111/pedi.12784 
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 Das Werk ist frei verfügbar
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Association of insulin-manipulation and psychiatric disorders [1.03 mb]
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Zusammenfassung (Englisch)

Background/Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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CC-BY-NC-Lizenz (4.0)Creative Commons Namensnennung - Nicht kommerziell 4.0 International Lizenz