1846-LB: Developing Best Practices for Preventing "Diabulimia"—Focusing on Health Care Professionals' Knowledge of Insulin Omission/Restriction

Introduction: Disordered eating behaviors (DEB) are common in type 1 diabetes (T1D), occurring in ~25% of young adults. DEBs are often characterized by insulin restriction and chronic hyperglycemia, increasing risk for future microvascular complications. This study focused on identification, prevention, and treatment of this high-risk condition by investigating healthcare professional (HCP) perceptions of the problem.

Methods: A semi-structured interview guide was developed to address topics such as: general eating disorder knowledge, knowledge of “diabulimia”, and resources needed to identify, prevent, and treat “diabulimia.” T1D HCPs identified by study team members underwent screening for eligibility based upon experience caring for patients with T1D prior to interviewing. Codes were developed inductively, with coding performed by two researchers attaining a kappa >0.70 (MAXQDA).

Results: Individual interviews (n=11) were conducted with T1D HCPs (2 MD/DO; 1 BSN/CDCES; 4 RD/CDCES; 3 NP/MSN; 1 NP/CDCES). Themes included a lack of: (a) information on DEBs, especially “diabulimia”, as these are not addressed in formal medical education; (b) knowledge about how best to initiate conversations and communicate with patients about DEBs; and (c) lack of diabetes mental health professionals available for referral. Suggested educational interventions included quick reference guides on communication techniques to use in the clinic; live training sessions to practice with standardized patients; and available referral networks for mental health professionals through the ADA and APA.

Conclusions: T1D HCPs identified need for more resources and education to help identify, discuss, and manage DEBs in people with T1D. Notably, a lack of mental health professionals remains a major hindrance. Future interviews with people with T1D in recovery from DEB can help guide HCPs in best practices to help manage DEBs.