Department of Pediatric and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
Department of Public Health, Epidemiology, Medical University Vienna, Vienna, Austria.
Pediatr Diabetes. 2019 Feb;20(1):127-136. doi: 10.1111/pedi.12784. Epub 2018 Oct 26.
BACKGROUND/OBJECTIVE: The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications.
Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records.
Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation.
This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
背景/目的：本研究旨在系统评估胰岛素操纵（故意过量或不足剂量的胰岛素）、精神共病和糖尿病并发症之间的关联。
对 21 家随机选择的奥地利糖尿病护理中心的 241 名 10-22 岁的 1 型糖尿病（T1D）患者进行了两次诊断访谈（糖尿病自我管理患者访谈和儿童精神障碍诊断访谈）。医疗数据来自病历。
在有胰岛素操纵的患者中，近一半（46.3%）存在精神共病，而在遵医嘱接受胰岛素治疗的患者中，这一比例为 17.5%。与未进行胰岛素操纵的患者相比，患有胰岛素操纵的患者更容易出现抑郁（18.3%比 4.9%）、特定恐惧症（21.1%比 2.9%）、社交恐惧症（7.0%比 0%）和饮食障碍（12.7%比 1.9%）。女性（37.7%）比男性（18.4%）更常被诊断出患有精神障碍（P=0.001）。在女性中，精神共病的比例随着胰岛素治疗不依从程度的增加而显著增加。与遵医嘱接受胰岛素治疗的患者相比，胰岛素操纵患者的 HbA1c 水平升高了 0.89%（P<0.001），而精神共病与代谢控制（HbA1c 8.16%比 8.12%[65.68 比 65.25mmol/mol]）之间无关联。在有胰岛素操纵的患者中，酮症酸中毒、严重低血糖和糖尿病中心门诊就诊频率最高。
这是第一项使用系统方法评估故意过量或不足剂量的胰岛素患者中精神障碍患病率的研究。内化性精神障碍与胰岛素操纵有关，尤其是在女性患者中，而胰岛素操纵与代谢控制恶化和糖尿病并发症有关。
