title: Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology.
abstract: OBJECTIVE
  Individuals with type 1 diabetes who restrict insulin to control weight are at high risk for diabetes-related complications and premature death. However, little is known about this behavior or how to effectively intervene. The aim of the current study was to identify predictors of insulin restriction in the natural environment that might inform new treatment directions.
  
  
  METHODS
  Eighty-three adults with type 1 diabetes and a range of eating disorder symptomatology completed 3 days of ecological momentary assessment. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) before eating and characteristics of the eating episode (e.g., eating a large amount of food) on the risk of insulin restriction.
  
  
  RESULTS
  Individuals who reported greater-than-average negative affect (general negative affect and negative affect specifically about diabetes) during the study period were more likely to restrict insulin. Momentary increases in anxiety/nervousness and guilt/disgust with self before eating (relative to an individual's typical level) further increased the odds of restricting insulin at the upcoming meal. Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., "no desserts").
  
  
  CONCLUSIONS
  Results suggest that insulin restriction might be decreased by helping patients with type 1 diabetes respond effectively to heightened negative affect (e.g., anxiety, guilt) and encouraging patients to take a less rigid, punitive approach to diabetes management.
authors.affiliation: Duke University Medical Center, Durham, NC rhonda.merwin@duke.edu.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Merwin
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Natalia O
authors.initials: NO
authors.lastname: Dmitrieva
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Honeycutt
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Moskovich
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: James D
authors.initials: JD
authors.lastname: Lane
authors.affiliation: Duke University Medical Center, Durham, NC Duke University, Durham, NC.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Zucker
authors.affiliation: Duke University Medical Center, Durham, NC Duke University, Durham, NC.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Surwit
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Mark
authors.initials: M
authors.lastname: Feinglos
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001835:Body Weight / Q000502:physiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D004435:Eating; D004644:Emotions; D001068:Feeding and Eating Disorders / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D015431:Weight Loss; D055815:Young Adult
chemical_list: D007328:Insulin