A Review on Diabulimia: Exploring the Intersection of Disordered Eating, Eating Disorders, Insulin Dose Manipulation, and Type 1 Diabetes.

Abstract

Background: Although insulin is essential for managing type 1 diabetes and is life-saving for patients with this condition, some individuals may intentionally reduce or omit insulin due to a fear of weight gain or a desire to lose weight. This behavior is commonly referred to as diabulimia.

Methods: Since diabulimia is not formally defined, a systematic review of the limited literature was conducted on November 8th, 2024, using PubMed, Scopus, and Web of Science databases. The search terms included "diabulimia", "insulin omission", "insulin restriction", "eating disorders", "disordered eating", and "type 1 diabetes". Out of 288 manuscripts, 19 were selected after excluding non-English articles and screening the titles and abstracts.

Results: Eating disorders and disordered eating are common in patients with type 1 diabetes, often driven by concerns regarding body image and weight. These behaviors can complicate diabetes management, worsen glucose control, and increase the risk of complications. Diabulimia may develop as a coping mechanism, especially in adolescents with higher body mass index and a history of eating disorders. Diagnosis is challenging due to the lack of established guidelines, but poor glucose control can raise suspicion and prompt further psychological evaluation. A multidisciplinary approach, combining medical care, nutrition, mental health support, and therapy, is recommended, despite limited evidence.

Conclusion: While diabulimia is not formally recognized, understanding its impact can help healthcare professionals diagnose and manage it more effectively, improving patients' health and well-being.