Experiences of Insulin Restriction or Omission in Type 1 Diabetes Mellitus: A Meta- Synthesis of Patient Experiences and Evidence-Based Guidance for Practice

Abstract

Diabetes mellitus is a significant health issue globally, contributing considerably to morbidity and mortality. Type 1 diabetes mellitus (T1DM), a specific type of diabetes mellitus, is a chronic endocrine disease characterised by insufficient insulin production which requires daily management. Research has shown that individuals withT1DM have increased rates of psychosocial issues, including disturbed eating behaviours compared to their nondiabetic peers. Unique to individuals with T1DM is a disordered eating behaviour whereby insulin is deliberately restricted or omitted, coined ‘diabulimia’. T1DM and its management present a unique set of biological, psychological and social eating disorder risk factors in addition to those imposed on the general population which may account for the higher prevalence of disordered eating behaviours observed. Disturbed eating behaviours and clinical eating disorders predispose individuals with T1DM to many complex medical risks and increased risks of morbidity and mortality, which highlights the importance of effective prevention strategies and interventions. As the empirical evidence surrounding this area of research continues to grow, it is evident that standard eating disorder treatments are ineffective among individuals with T1DM, and currently, there is a lack of consensus on best practice. For this reason, it is critical to increase understanding about the thoughts, beliefs and experiences associated with disordered eating behaviours and, specifically, the intentional restriction and omission of insulin within individuals with T1DM. This review aims to identify, analyse and synthesise existing knowledge about disordered eating behaviour among individuals with T1DM with a focus on the deliberate restriction and omission of insulin for weight loss.