Insulin omission is a serious concern for those with type 1 diabetes (T1D), predicting subsequent complications and mortality. It is, thus, imperative to understand factors that may elevate insulin omission, especially during late adolescence when risk behaviors are increasing and T1D management is low. We examined how two interrelated factors – emotion dysregulation and depressive symptoms – may be related to insulin omission during late adolescence. A mediation model examined whether emotion dysregulation was associated indirectly with insulin omission through enhanced depressive symptoms, as has been shown in prior disordered eating literature. A moderation model examined whether emotion dysregulation exacerbated associations of depressive symptoms with insulin omission. Seniors in high school with T1D longer than one year (N = 236) completed measures of depressive symptoms, difficulties in emotion regulation (DERS), and diabetes self-management behaviors, as well as a one-item measure of insulin omission for the purpose of losing weight, and a mail-in assay kit to assess HbA1c. Consistent with prior research, most participants reported they never skip insulin to lose weight, but 39 (17%) reported they skip insulin for the specific purpose of losing weight at least some of the time. Individuals who indicated they sometimes skip insulin to lose weight had higher (poorer) HbA1c than those who never skip insulin, M = 8.94 vs 8.14%, which is a clinically meaningful difference. Each of the six DERS subscales and depressive symptoms were individually correlated with greater insulin omission (rs > .140). Logistic regressions in MPLUS were utilized to examine whether DERS subscale scores were associated with insulin omission both directly, as well as indirectly through greater depressive symptoms. This mediation model was supported, as the indirect path through depressive symptoms was significant for each facet of emotional dysregulation on insulin omission. Tests of moderation revealed no significant interactions between depressive symptoms and DERS subscales, suggesting that depressive symptoms pose risks for insulin omission even among those with good emotion regulation skills. Programs to develop emotion regulation skills and minimize depressive symptoms, and screening for insulin omission especially among those with elevated depressive symptoms may be helpful at this high-risk time of development.

Insulin restriction occurs when a person with diabetes takes less insulin than is prescribed and can occur for non-specified reasons (IR) or for specific reasons such as weight control (IRWC). This behavior has been associated with dangerous outcomes such as unhealthy elevations in blood glucose and mortality. IR may be particularly problematic during the transition from adolescence to emerging adulthood when other risky behaviors (e.g., disordered eating behaviors) and diabetes mismanagement commonly increase. Parental knowledge, disclosures to, and secrecy from parents are aspects of parental involvement that have been associated with increased risk behaviors and diabetes mismanagement in emerging adulthood. The present longitudinal study examined whether IR or IRWC increase from adolescence to emerging adulthood, and whether these aspects of parental involvement in diabetes may be predictors of insulin restriction during this time. Late adolescents who had been diagnosed with type 1 diabetes for longer than one year were recruited during their senior year of high school (N=236, 61% female; Mage=17.7 years) and surveyed annually for four years. IR and IRWC were measured with commonly used single items (e.g., “How often do you take less insulin than you should?”). Adolescent perceptions of parental knowledge about their diabetes self-care, as well as their diabetes-related disclosures to and secrecy from parents were measured separately for mothers and fathers. In contrast to expectations, unconditional growth curve models indicated IR declined across the four years while IRWC showed no linear change across time. Conditional models examining between-person effects revealed higher maternal knowledge, and lower secrecy from mothers and fathers at time 1 predicted lower IR at time 1, but also slower declines in IR across time. No between-person time 1 predictors were associated with IRWC intercept or slope. Time-varying covariate models revealed within-person fluctuations in parental involvement variables were associated with fluctuations in both IR and IRWC. In years when maternal knowledge and disclosure to fathers were higher than a person’s own average, and when secrecy to mothers and fathers were lower than a person’s average, IR was lower. Similarly, in years when disclosure to mothers was higher than a person’s own average and secrecy from fathers was lower than a person’s average, IRWC was lower. This research suggests that parental involvement in diabetes management remains important during early emerging adulthood and may represent a modifiable behavior to prevent or reduce IR.

Background

Methods

Results

Conclusions