ABSTRACT
BACKGROUND/OBJECTIVE: The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. METHODS: Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. RESULTS: Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation. CONCLUSIONS: This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
Subject(s)
Diabetes Complications/epidemiology , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Insulin/administration & dosage , Neurodevelopmental Disorders/epidemiology , Prescription Drug Misuse/statistics & numerical data , Adolescent , Adult , Child , Comorbidity , Diabetes Complications/psychology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/psychology , Female , Humans , Insulin/adverse effects , Male , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Neurodevelopmental Disorders/complications , Prescription Drug Misuse/adverse effects , Prescription Drug Misuse/psychology , Psychology, Adolescent/statistics & numerical data , Young AdultABSTRACT
Resumo O objetivo deste estudo foi realizar um estudo ictioparasitológico sobre a espécie Hemiodopsis microlepis (peixes de arqueiros), do rio Gurguéia, situada em Bom Jesus-Piauí, Brasil. Coletaram-se trinta espécimenes de Hemiodopsis microlepis, aos quais realizou-se uma análise morfológico externo e coleta de pequenos fragmentos das branquias, fígado, rins e intestinos para identificar os parasitas Myxobolus sp., Henneguya sp. e Camallanus sp. em um microscópio óptico (40X). Aproximadamente 90 % dos peixes examinados foram parasitados por myxosporidos pertencentes à família Myxobolidae, dos quais ao redor do 20 % foram parasitados por Henneguya sp. e o 70 % foram parasitados por Myxobolus sp. Solo o 5% das espécimenes parasitados por Myxobolus sp. foram também parasitados por nematódeos. O estudo de ictioparasitologia realizado sobre a espécie Hemiodopsis microlepis confirmou a presença de parasitas Myxobolus sp. e Henneguya e os nematódeos da espécie Camallanus sp.
Abstract The objective of this study was to carry out an ichthyoparasitological study on the species Hemiodopsis microlepis (archerfish) of the Gurguéia River, located in Bom Jesus Piauí, Brazil. Thirty specimens of Hemiodopsis microlepis were collected, which underwent an external morphological analysis and collection of small fragments of gills, liver, kidneys, and intestines to identify the parasites Myxobolus sp., Henneguya sp., and Camallanus sp., using an optical microscope (40X). About 90% of the examined fish were parasitized by myxosporids belonging to the Myxobolidae family, of which around 20% were parasitized by Henneguya sp., and 70% were parasitized by Myxobolus sp. Only 5% of the specimens parasitized by Myxobolus sp. were also parasitized by nematodes. The ichthyoparasitological study of the species Hemiodopsis microlepis confirmed the presence of the parasites Myxobolus sp. and Henneguya sp., as well as the nematodes of the species Camallanus sp.
Resumen El objetivo de este estudio fue realizar un estudio ictioparasitológico sobre la especie Hemiodopsis microlepis (peces de arqueros), del río Gurguéia, situada en Bom Jesus-Piauí, Brasil. Se recolectaron treinta especímenes de Hemiodopsis microlepis, a los que se les realizó un análisis morfológico externo y recolección de pequeños fragmentos de las branquias, hígado, riñones e intestinos para identificar los parásitos Myxobolus sp., Henneguya sp. y Camallanus sp. en un microscopio óptico (40X). Alrededor del 90 % de los peces examinados fueron parasitados por myxosporidos pertenecientes a la familia Myxobolidae, de los cuales alrededor del 20 % fueron parasitados por Henneguya sp. y el 70 % fueron parasitados por Myxobolus sp. Solo el 5% de los especímenes parasitados por Myxobolus sp. fueron también parasitados por nematodos. El estudio ictioparasitológico realizado sobre la especie Hemiodopsis microlepis confirmó la presencia de parásitos Myxobolus sp. y Henneguya y los nematodos de la especie Camallanus sp.