The Need for Clinician Communication Strategies for Eating Disorders/Insulin Restriction in Type 1 Diabetes

Le résumé fourni par la source

Disordered eating behaviors occur more frequently in people with Type 1 diabetes (T1D). Having T1D and eating disorders (T1DE) more than triples the risk of DKA and death compared to those without eating disorders (ED). Insulin restriction involves purposely under-dosing or omitting insulin to lose weight. The primary objective was to identify the unique obstacles faced by diabetes healthcare clinicians (HCs) in their communication with patients who have suspected T1DE/insulin restriction, and HCs' educational needs and preferred approaches in working with T1DE. Semi-structured virtual interviews were conducted with diabetes HCs (n=17). An inductive codebook was developed to analyze transcripts, with interrater reliability established by two coders (kappa = 0.9). Themes were developed across categories, codes, and coded segments. HCs discussed three themes surrounding T1DE and insulin restriction: (1) HCs felt more confident in identifying T1DE/insulin restriction through clinical indicators than in treating T1DE; (2) The majority of HCs were not confident in knowing what to say after identifying a patient with insulin restriction; and (3) HCs discussed the need for more resources and T1DE training, and provided feedback on preferred methods of education. T1DE/insulin restriction is a challenge to address and manage in diabetes clinics. More hands-on training (e.g., communication workshops, standardized patient simulations, or structured educational tools) is needed for HCs to have meaningful conversations around T1DE/insulin restriction. Earlier recognition of insulin restriction and timely intervention could potentially reduce acute complications, including DKA, and improve long-term outcomes.

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