Women with type 1 diabetes who cut back on insulin face a threefold higher risk of early death and higher rates of disease complications as compared to those who do not skip the needed insulin shots, a new study has found.
Type 1 diabetes is the autoimmune form of the disease, in which the body is no longer able to produce insulin, a hormone which allows the body to utilize and store calories for energy.
The study highlights the risk involved in restricting insulin, a practice that often goes hand in hand with an eating disorder, said Ann Goebel-Fabbri, a psychologist at the Joslin Diabetes Center in Boston and the study's lead author.
Eating disorder symptoms include extreme concern for body weight and shape, judging self worth according to a thin body ideal, restrictive eating patterns, binge eating and other methods of purging calories, such as vomiting.
In the 11-year study, 234 women were followed to show an increased risk of mortality as well as higher rates of kidney and foot problems in those who restricted their insulin intake.
In addition, the average age of death was younger for those involved in insulin restriction: 45 years of age as compared to 58 years for those who did not restrict.
Thirty percent of the subjects reported restricting their insulin intake at the study's outset. Frequency of the behavior appears to influence mortality risk. Insulin-restricting women who died had reported more frequent insulin restriction and reported more eating disorder symptoms at the study's outset than those insulin-restrictors who were still living at study's end.
'This is an incredibly important women's health issue in the area of diabetes. The average age of death was significantly younger in the insulin-restricting group. This behavior emerged as a significant risk factor for mortality,' Goebel-Fabbri said.
The study suggests that insulin restriction and related eating disorder behaviors may be unique barriers to achieving optimal diabetes management, Goebel-Fabbri said.
'Women with this behavior need specialized treatment by someone who understands the connection between eating disorders and diabetes,' she said.
'We know that current type 1 diabetes treatment is especially good at preventing complications and preserving longevity. The biggest frustration is knowing that these women, by virtue of their eating disorders, are unable to utilize that lifesaving set of tools,' she added.
The study is published in Diabetes Care.