In a symposium presented at the 82^nd Scientific Sessions of the American Diabetes Association (ADA), Professor Katharine Barnard-Kelly, PhD, chair of the governing committee of the FDA Reducing Suicide Rates Among Individuals with Diabetes (RESCUE) Collaborative Community discusses the relationship between suicide/self-harm and type 1 diabetes (T1D).

The risk for suicide is significantly higher among individuals with diabetes, especially in T1D, and could account for up to 7% of deaths in this population. However, in reality, this could only be the tip of the iceberg.

What the data reveal

Suicidal ideation among people with T1D is 15% vs 9.4% in the general population. This figure may be as high as 61% among adolescents and young adults with T1D. People with T1D are 3-4 times more likely to attempt suicide. The World Health Organization estimates that for each suicidal death, there are at least 20 suicide attempts among people with diabetes.

The complexities of intentional self-injury (ISI) behavior are different for people with T1D. Apart from the typical self-harm acts, such individuals are also likely to engage in insulin mismanagement with the intent of harming themselves.

Rates of suicide and ISI are likely to be significantly underestimated in people with T1D. A study involving 160 cases of insulin overdose found 90% of the cases to be either suicidal or parasuicidal and only 5% were found to have occurred accidentally. Another issue is that death certificates or International Classification of Diseases codes used to report causes of death are often unreliable, adding to the underreporting of suicide in T1D.

Furthermore, there are gender differences in suicide risk. Men are more likely to complete suicide than women; however, women have more suicide attempts. Men are also less likely to seek help for their mental health issues.

Why is the risk higher with diabetes?

The management of diabetes is becoming increasingly burdensome and complex, and for many, it may be associated with depression, self-injury, and suicidal thoughts and acts. Diabetes in itself is a psychologically demanding condition. Even with improvements in the medical management of T1D, the emotional and psychological burden of living with diabetes remains unaddressed.

People who self-manage diabetes are often concerned about their self-worth, strength of relationships, what the future holds, and opportunities for education and employment.

The role of technology

There have been significant advances in diabetes technology that have led to improvements in glycemic control, quality of life, and psychosocial functioning, but the psychological burden associated with using these complex systems remains unrecognized.

Prof Barnard-Kelly emphasizes that technology is 'NOT' the cause of suicide and ISI but rather has enabled clinicians to identify the magnitude of the issue. However, technologies do offer easier methods for injurious behaviors by simplifying insulin administration and potential misuse.

Challenges with identification

The currently available screening tools for depression and suicide are not adequately effective in identifying the risk of suicide in people with T1D.

Healthcare professionals not only fail to correctly estimate the suicide risk in their patients but often feel unsupported to tackle this problem.

FDA RESCUE Collaborative Community

The FDA RESCUE Collaborative Community was set up with the goal of facilitating collaboration between various stakeholders involved in diabetes management to improve the identification of suicide and ISI among people with diabetes and provide the necessary support to those at risk.

ADA 2022 — Uncovering the hidden peril of suicide and self-harm in diabetes

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