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. 2019 Feb;20(1):127-136.
doi: 10.1111/pedi.12784. Epub 2018 Oct 26.

Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria

Gabriele Berger  1 , Thomas Waldhoer  2 , Irene Barrientos  3 , Daniela Kunkel  1 , Birgit M Rami-Merhar  1 , Edith Schober  1 , Andreas Karwautz  3 , Gudrun Wagner  3
Affiliations

Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria

Gabriele Berger et al. Pediatr Diabetes. 2019 Feb.

Abstract

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.

Keywords: adolescent; diabetes complications; medication adherence; mental disorders; psychology.

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Figures

Figure 1
Figure 1
Percentage of psychiatric comorbidity in the adherence groups ([P = 0.001] Cochran‐Armitage trend test)
Figure 2
Figure 2
Gender effect on psychiatric comorbidity (Cochran‐Armitage trend test)
See this image and copyright information in PMC

References

    1. Fritsch M, Rosenbauer J, Schober E, Neu A, Placzek K, Holl RW. Predictors of diabetic ketoacidosis in children and adolescents with type 1 diabetes. Experience from a large multicentre database. Pediatr Diabetes. 2011;12:307‐312. - PubMed
    1. Schwandt A, Hermann JM, Rosenbauer J, et al.; DPV Initiative.Longitudinal trajectories of metabolic control from childhood to young adulthood in type 1 diabetes from a large German/Austrian registry: a group‐based modeling approach. Diabetes Care. 2017;40:309‐316. - PubMed
    1. Hoey H. Psychosocial factors are associated with metabolic control in adolescents: research from the Hvidoere Study Group on childhood diabetes. Pediatr Diabetes. 2009;10(Suppl 13):9‐14. - PubMed
    1. Hamilton J, Daneman D. Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab. 2002;15:115‐126. - PubMed
    1. Du Pasquier‐Fediaevsky L, Chwalow AJ, Tubiana‐Rufi N. Is the relationship between adherence behaviours and glycaemic control bi‐directional at adolescence? A longitudinal cohort study. Diabet Med. 2005;22:427‐433. - PubMed

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