Managing factitious disorder and type 1 diabetes

Factitious disorder is a condition in which a patient feigns the symptoms of an illness in order to assume the sick role and get care. Less common is the context in which a patient has a genuine illness, but adopts non-compliance or other behaviours likely to worsen the illness. This is more difficult to identify and to treat. We present two cases of patients with type 1 diabetes mellitus, affected by factitious disorder.We describe the impact of the disorder on their glucose control and general health, the challenges faced in diagnosing the psychiatric condition, and how the resulting situations were managed in a secondary care setting.We highlight the strategies often employed by patients in factitious disorder, and suggest counter-strategies that can be implemented to minimise risk to patients. Ultimately, timely therapy for the factitious disorder could aid glucose control, and the overall health of the patient.