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Peer-reviewedCC BY-NC-ND 4.0AACE Endocrinology and Diabetes

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

  • Heather L. Stuckey1
  • Candace R. Bordner2
  • Amie L. Prokop3
  • Elena Toschi4,5
  • Ann E. Goebel-Fabbri6
  • Lori M. Laffel7
7 affiliations
  1. 1Penn State College of Medicine, Department of Medicine, Academic Support Building, Division of General Internal Medicine, Hershey, Pennsylvania
  2. 2Penn State College of Medicine, Department of Medicine, Division of General Internal Medicine, Hershey, Pennsylvania
  3. 3Penn State Health Hershey Medical Center, Division of Endocrinology, Hershey, Pennsylvania
  4. 4Harvard Medical School, Joslin Diabetes Center, Adult Diabetes, Clinical Research (Joslin), Boston, Massachusetts
  5. 5Department of Medicine (Harvard Medical School), Boston, Massachusetts
  6. 6Dr. Goebel-Fabbri, LLC, Brookline, Massachusetts
  7. 7Harvard Medical School, Joslin Diabetes Center, Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Center for Life Sciences, Boston, Massachusetts
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Abstract

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 diabetic ketoacidosis and death compared to those without eating disorders. 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 inter-rater reliability established by 2 coders (kappa = 0.9). Themes were developed across categories, codes, and coded segments. HCs discussed 3 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 (eg, 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 diabetic ketoacidosis, and improve long-term outcomes.

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Cite

BibTeXRIS
BibTeX
@article{stuckey2026need,
  title = {{The Need for Clinician Communication Strategies for Eating Disorders/Insulin Restriction in Type 1 Diabetes}},
  author = {Heather L. Stuckey and Candace R. Bordner and Amie L. Prokop and Elena Toschi and Ann E. Goebel-Fabbri and Lori M. Laffel},
  journal = {AACE Endocrinology and Diabetes},
  year = {2026},
  month = jul,
  doi = {10.1016/j.aed.2026.07.004},
  url = {https://doi.org/10.1016/j.aed.2026.07.004},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - The Need for Clinician Communication Strategies for Eating Disorders/Insulin Restriction in Type 1 Diabetes
AU  - Heather L. Stuckey
AU  - Candace R. Bordner
AU  - Amie L. Prokop
AU  - Elena Toschi
AU  - Ann E. Goebel-Fabbri
AU  - Lori M. Laffel
PY  - 2026
DA  - 2026/07/09
JO  - AACE Endocrinology and Diabetes
DO  - 10.1016/j.aed.2026.07.004
UR  - https://doi.org/10.1016/j.aed.2026.07.004
AB  - 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 diabetic ketoacidosis and death compared to those without eating disorders. 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 inter-rater reliability established by 2 coders (kappa = 0.9). Themes were developed across categories, codes, and coded segments. HCs discussed 3 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 (eg, 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 diabetic ketoacidosis, and improve long-term outcomes.
SN  - 3050-9157
ER  -