Eating Attitudes, Insulin Adherence, and Diabetes Control in Adults with Type 1 and Type 2 Diabetes

Abstract

Background: Maladaptive eating attitudes in people with diabetes has been associated with poor diabetes self-management, poor diabetes control, and worse disease outcomes. In addition, maladaptive eating behaviors have been associated with insulin misuse for weight control, which also correlates with poor diabetes control. However, most of the research on maladaptive eating attitudes and behaviors in diabetes has been conducted on adolescent females with type 1 diabetes. This study investigates the differences in eating attitudes and insulin adherence in people with type 1 diabetes and type 2 diabetes, and the interrelationships between eating attitudes, insulin adherence and diabetes control. Lastly, this study also investigates whether type of diabetes moderates the relationship between insulin adherence and HbAlc levels.;Methods: The sample consisted of 125 participants with type 1 diabetes mellitus or type 2 diabetes mellitus who were recruited through Albert Einstein College of Medicine or Montefiore Medical Center. Participants completed measures of maladaptive eating attitudes, insulin adherence, body image and depressive symptoms. Additionally, HbAlc levels and height/weight were also obtained. The data was analyzed cross-sectionally. Results: Participants with type 1 diabetes were less likely to worry about gaining weight due to insulin (t(72) = -.21, p=.02) and more likely to take their insulin medication (t(70) = .76, p=.03) than those with type 2 diabetes. Maladaptive eating attitudes were not related to lower rates of insulin adherence (beta = 0.88, p = 0.46) but were related to worry about weight gain due to insulin (beta = .25, p = .03). A significant inverse relationship was found between insulin adherence and HbAlc levels (beta = -.29, p = .03) but no relationship was found between worry about weight gain due to insulin and HbAlc levels (beta = .02, p = .88). Depression was positively correlated with worry about weight gain (r=.33, p=.005) and inversely correlated with insulin adherence (r= -.25, p=.04). Type of diabetes diagnosis did not moderate the relationship between insulin adherence and HbAlc levels (beta= -0.43, p=.32) and no evidence for insulin adherence mediating the relationship between maladaptive eating attitudes and HbAlc levels were found. Conclusions: The findings did not support a direct association between maladaptive eating attitudes and insulin nonadherence in adults with type 1 and type 2 diabetes. However, maladaptive eating attitudes were associated with worry about weight gain due to insulin, a previously reported reason for insulin nonadherence. Additionally, worry about weight gain due to insulin and body image dissatisfaction were associated with depression. Clinicians should regularly assess insulin adherence, particularly in patients who are having difficulty controlling their diabetes. Similarly, if a patient presents with depressive symptoms, clinicians should consider assessing for other psychological issues such as worry about weight gain due to insulin and body image dissatisfaction.