Taking less insulin than required to control type 1 diabetes can cut a woman's lifespan by more than a decade, according to research conducted at the Joslin Diabetes Centre in Boston.
Fear of hypoglycaemia (low blood sugar) and concern about gaining weight may lead patients with type 1 diabetes to restrict necessary insulin doses, Dr Katie Weinger and colleagues note in a report in the journal Diabetes Care.
In their 11-year follow-up study of 234 type 1 diabetic women, those who restricted their insulin intake had an increased risk of death as well as higher rates of kidney and foot problems relative to women who did not restrict their insulin dose.
In addition, the average age of death was younger for those involved in insulin restriction: 45 years of age as compared to 58 years for those who did not restrict.
At the start of the study, 71 women (30 percent) had been classified as insulin restrictors, based on a positive response to the screening item "I take less insulin than I should."
Death risk increase threefold
Twenty-six women died during follow-up, including 10 insulin restrictors. Insulin restriction increased the relative risk of death more than threefold after adjusting for other factors.
Insulin-restricting women who died reported more frequent insulin restriction and reported more eating disorder symptoms at the study's outset than those insulin-restrictors who were still living at study's end. Studies have shown that women with diabetes are nearly 2.5 times more likely than women without diabetes to develop an eating disorder.
Weinger and colleagues think doctors should ask their patients with type 1 diabetes if they take less insulin than they are supposed to, and refer high-risk patients to mental health professionals. - (Reuters Health)
SOURCE: Diabetes Care, March 2008.
What is type 1 diabetes?