Diabulimia in Type 1 Diabetes: Psychological, Metabolic, and Clinical Consequences - A Narrative Review

Background: Type 1 diabetes mellitus (T1D) is associated with increased psychological burden and higher risk of disordered eating behaviors. Intentional insulin restriction or omission for weight control, commonly referred to as diabulimia, may lead to severe metabolic and psychological complications. Aim: This narrative review summarizes current evidence regarding the prevalence, psychological mechanisms, biological consequences, diagnostic challenges, quality of life impairment, and treatment approaches associated with intentional insulin restriction in patients with T1D. Methods: This narrative review included studies indexed in PubMed and Google Scholar, with primary focus on publications from the last 10 years. Narrative reviews, systematic reviews, meta-analyses, consensus statements, and selected original studies related to diabulimia, insulin omission, diabetes distress, and eating disorders in T1D were analyzed. Results: Adolescents and young women with T1D appear to be at increased risk of developing disordered eating behaviors compared to the general population. Intentional insulin omission may result in hyperglycemia, glycosuria, dehydration, lipolysis, diabetic ketoacidosis, accelerated microvascular complications, and increased mortality risk. Diabetes distress, body dissatisfaction, chronic disease burden, and sociocultural pressure related to body image appear to play important roles in the development of diabulimia. Early diagnosis remains difficult because symptoms may resemble poor treatment adherence. Conclusions: Diabulimia represents a serious and underrecognized complication of T1D requiring multidisciplinary management. Early identification, psychological support, and integration of psychodiabetological care into routine diabetes management may improve both metabolic and psychological outcomes. Further research is needed to establish standardized diagnostic criteria and evidence-based treatment strategies.