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Association of insulin‐manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria
Author(s) -
Berger Gabriele,
Waldhoer Thomas,
Barrientos Irene,
Kunkel Daniela,
RamiMerhar Birgit M.,
Schober Edith,
Karwautz Andreas,
Wagner Gudrun
Publication year - 2019
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12784
Subject(s) - medicine , insulin , diabetes mellitus , comorbidity , ketoacidosis , diabetic ketoacidosis , psychiatry , depression (economics) , type 1 diabetes , hypoglycemia , type 2 diabetes , pediatrics , endocrinology , economics , macroeconomics
Background/Objective The aim of this study was to systematically assess the association of insulin‐manipulation (intentional under‐ and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. Methods Two diagnostic interviews (Diabetes‐Self‐Management‐Patient‐Interview and Children's‐Diagnostic‐Interview for Psychiatric Disorders) were conducted with 241 patients (age 10‐22) 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 insulin‐manipulation (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 insulin‐manipulation. 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 non‐adherence to insulin therapy. Insulin‐manipulation 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 insulin‐manipulation. 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 insulin‐manipulation, especially in female patients and insulin‐manipulation was associated with deteriorated metabolic control and diabetes complications.