207-OR: Intentional Insulin Omission for Weight Loss and Psychosocial Outcomes among Youth with Type 1 Diabetes: Findings from Routine Screening

Introduction: Research has found that up to 31% of youth with type 1 diabetes (T1D) restrict insulin in efforts to lose weight (Wisting et al., 2013), and that restricting or omitting insulin has been linked to higher HbA1c. However, less is known about psychosocial outcomes among youth who omit insulin. The purpose of the current study was to examine associations between intentional omission of insulin to lose or avoid gaining weight and psychosocial outcomes among youth with T1D.

Methods: Participants included 54 youth with T1D ages 12-17 (M age = 14.7, 55.6% female) and their caregivers, recruited during routine diabetes clinic visits. Youth and caregivers completed an annual psychosocial screening battery which included the PROMIS® depression and anxiety scales, the Problem Areas in Diabetes measure, and the Diabetes Family Conflict Scale. Youth also answered questions on their intentional omission of insulin to either lose or avoid gaining weight. Analyses were conducted via Pearson’s correlations, t-tests, and Chi-square tests.

Results: Intentional omission of insulin to lose or avoid gaining weight was significantly positively correlated with youth-report of depression, anxiety, diabetes distress, and diabetes-related family conflict. Compared to youth who do not intentionally omit insulin, those who do omit insulin were more likely to have clinically elevated levels of depression (p’s < .05). No differences for parent-reported psychosocial outcomes were found.

Conclusions: Results reveal that youth who intentionally omit insulin for weight purposes are at risk for poorer psychosocial outcomes, especially depression. Additional research is needed to understand the causal direction of these associations, and to examine the potential role of disordered eating behavior. Results also highlight how psychosocial screening during routine diabetes visits can identify youth and caregivers in need of behavioral health interventions.