title: Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes.
abstract: OBJECTIVE
  Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c).
  
  
  METHODS
  Two-hundred and seventy-six individuals with type 1 diabetes completed an online survey of eating behaviors, insulin dosing and most recent HbA1c. We used structural equation modeling to test the hypothesis that disinhibited eating when blood sugar is thought to be low predicts weight-related insulin mismanagement, and this, in turn, predicts higher HbA1c.
  
  
  RESULTS
  The majority of participants endorsed some degree of disinhibition when they think their blood glucose is low (e.g., eating foods they do not typically allow) and corresponding negative affect (e.g., guilt/shame). The frequency of disinhibited eating was positively associated with weight-related insulin mismanagement. Controlling for age, sex, education, and insulin pump use, the model explained 31.3% of the variance in weight-related insulin mismanagement and 16.8% of the variance in HbA1c.
  
  
  CONCLUSIONS
  Addressing antecedents to disinhibited eating that are unique to type 1 diabetes (e.g., perceived BG level) and associated guilt or shame may reduce weight-related insulin omission.
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710. Electronic address: rhonda.merwin@duke.edu.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Merwin
authors.affiliation: Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Moskovich
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710.
authors.forename: Natalia O
authors.initials: NO
authors.lastname: Dmitrieva
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710.
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Honeycutt
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710; Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Zucker
authors.affiliation: Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710; Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Surwit
authors.affiliation: Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708.
authors.forename: Lori
authors.initials: L
authors.lastname: Buhi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001835:Body Weight; D002032:Bulimia / Q000097:blood / Q000150:complications / Q000523:psychology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000523:psychology*; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007266:Inhibition, Psychological; D007328:Insulin / Q000008:administration & dosage / Q000097:blood; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
keywords: Diabetes; Eating disorder; Insulin mismanagement