FPI profiles in a European sample of 1068 female patients suffering from anorexia or bulimia nervosa

Thirty‐two centres from nine European countries participated in a research programme about eating disorders. This study presents results of patients aged 17–26 years suffering from anorexia (N = 418) and bulimia nervosa (N = 650) according to DSM‐IV criteria (American Psychiatric Association, 1994). Patients' personality profiles were assessed with the revised version of the Freiburger Personality Inventory (FPI‐R). Compared to the comparison subjects, the eating‐disordered patients showed lower life satisfaction, health concern and extraversion and higher social orientation, inhibition, irritability, strain, somatic complaints, frankness and emotionality. Anorexic patients had similar scores to the comparison group on achievement orientation and aggressiveness scales. Non‐purging bulimic patients were not different from comparison subjects in aggressiveness and purging bulimic patients showed no difference for extraversion. Differences in the diagnostic subgroups are discussed in light of the literature in this area. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

The impact of a motivational assessment interview on initial response to treatment in adolescent anorexia nervosa

This study was a pilot for a larger study to evaluate a time‐limited outpatient programme for adolescent anorexia nervosa, to explore the ability of an assessment interview to change self‐reported motivation and ascertain the extent to which this predicted engagement with treatment and early behavioural change. Forty‐two adolescents with anorexia nervosa rated their motivation for change before and after attending a new‐style assessment interview. Initial (6 week) effectiveness of the programme was evaluated by measuring engagement with treatment, weight change, clinician (HoNOSCA) and self‐rated (EDI, MFQ, HoNOSCA‐SR) outcome measures, overall and in relation to motivational status. The assessment interview significantly improved motivation. Motivational category after interview was unrelated to physical status, cognition or general functioning but predicted engagement with treatment. Whilst for the whole sample, treatment produced physical, cognitive and general improvements at 6 weeks, motivational status was a powerful predictor of weight gain. A client‐centred assessment interview engaged 80% in an outpatient programme based on CBT. Motivational enhancement may improve engagement and specifically result in behavioural change and early weight gain. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

A study of bone density change in patients with anorexia nervosa

In patients with anorexia nervosa (AN) several factors combine to cause osteoporosis, and the risk of osteoporosis increases with chronicity of illness. The authors carried out a follow‐up study in patients who attended the Eating Disorders department of the Hospital de Santa Maria. The average follow‐up period was of 7.6 years. Fifteen patients were included. Patients answered clinical history questions and underwent neck of femur and spine densitometry. The most important variable with negative correlations to bone recovery was disease duration. A positive correlation between bone recovery and time since the first menstrual cycle post‐amenorrhea was also found. However, AN is a condition in which once weight improves and menstrual cycles become regular, severe damage to bone structure is still likely to be maintained. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Continuous glucose monitoring for treatment adjustment in diabetic pregnancies--a pilot study.

AIMS: To examine the efficacy of a continuous glucose monitoring (CGM) system for treatment adjustment in patients with diabetic pregnancy treated with insulin. METHODS: The study sample consisted of eight women with diabetic pregnancy, six with pre-pregnancy Type 1 diabetes mellitus and two with gestational diabetes (GDM), all being treated with multiple daily insulin injections. Gestational age ranged from 24 to 32 weeks. Data derived from the Continuous Glucose Monitoring System (MiniMed) for 72 h were compared with fingerstick glucose measurements (six to eight times a day), and treatment was adjusted on the basis of the findings. Two to four weeks later, the patients were re-evaluated with CGM. RESULTS: In the first part of the study, an average of 744+/-33 glucose measurements was recorded for each patient with CGM. The mean total time of hyperglycaemia (glucose level >7.7 mmol/l) undetected by the fingerstick method was 152+/-33 min/day. Nocturnal hypoglycaemic events (glucose level <2.7 mmol/l) were recorded in seven patients. Based on the additional information obtained by continuous monitoring, the insulin regimen was changed in all patients. CGM re-evaluation after treatment adjustment showed a reduction in undetected hyperglycaemia to 89+/-17 min/day and in nocturnal hypoglycaemic events, which were recorded in only one patient. CONCLUSIONS: Continuous glucose monitoring may diagnose high blood glucose levels and nocturnal hypoglycaemic events that are unrecognized by intermittent blood glucose monitoring and could serve as a useful tool for the long-term management of diabetic pregnancies. A large prospective study is needed to determine the clinical implications of this new monitoring technique.     

Energy cost of physical activity in patients with anorexia nervosa

To assess the amount of energy cost for a standardized physical activity, activity‐induced thermogenesis (AIT) was measured in eight hyperactive and eight sedentary patients with anorexia nervosa as well as in 14 sport students and 14 sedentary controls. Resting metabolic rate (RMR) and AIT were measured by indirect calorimetry. RMR was measured after an overnight fast and began 20 min after the placement of the hood and lasted for 20 min. For the next 10 min subjects had to ride a recumbent bicycle ergometer (25 W) and AIT was measured. Absolute RMR in both anorectic groups was significantly lower than in both normal weight groups, but after adjusting for lean body mass (LBM) RMR did not differ among the groups. Absolute AIT was significantly lower in hyperactive anorectic patients and in sport students compared to the controls. After adjusting for LBM AIT was still significantly lower in the hyperactive anorectic group and in the group of sport students compared to the control group. These results indicate that despite severe underweight and biological changes in muscles anorectic patients still have an energy sparing metabolism during moderate physical activity. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Understanding the experience of drop‐out from treatment for anorexia nervosa

Research suggests that approximately 50 per cent of patients drop out prematurely from services for anorexia nervosa. This research set out to investigate the possible reasons for this high drop‐out rate. The experiences of eight women were explored through written accounts and semi‐structured interviews. The information was analysed using a social constructionist revision of grounded theory. A central theme of control emerged which was affected by interactions with the wider social system. The cumulative battle for control between the anorectic and others appeared to result in the act of dropping out as the treatment approach, timing and context recreated the setting conditions of lost control. The organizational and clinical implications of this model are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Nocturnal hypoglycaemia in Type 1 diabetic patients,assessed with continuous glucose monitoring: frequency,duration and associations

Aims We quantified the occurrence and duration of nocturnal hypoglycaemia in individuals with Type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) or multiple‐injection therapy (MIT) using a continuous subcutaneous glucose sensor. Methods A microdialysis sensor was worn at home by 24 patients on CSII (mean HbA_1c 7.8 ± 0.9%) and 33 patients on MIT (HbA_1c 8.7 ± 1.3%) for 48 h. Occurrence and duration of nocturnal hypoglycaemia were assessed and using multivariate regression analysis, the association between HbA_1c, diabetes duration, treatment type (CSII vs. MIT), fasting and bedtime blood glucose values, total daily insulin dose and mean nocturnal glucose concentrations, and hypoglycaemia occurrence and duration was investigated. Results Nocturnal hypoglycaemia ≤ 3.9 mmol/l occurred in 33.3% of both the CSII‐ (8/24) and MIT‐treated patients (11/33). Mean (± sd ; median, interquartile range) duration of hypoglycaemia ≤ 3.9 mmol/l was 78 (± 76; 57, 23–120) min per night for the CSII‐ and 98 (± 80; 81, 32–158) min per night for the MIT‐treated group. Multivariate regression analysis showed that bedtime glucose value had the strongest association with the occurrence (P = 0.026) and duration (P = 0.032) of nocturnal hypoglycaemia. Conclusions Microdialysis continuous glucose monitoring has enabled more precise quantification of nocturnal hypoglycaemia occurrence and duration in Type 1 diabetic patients. Occurrence and duration of nocturnal hypoglycaemia were mainly associated with bedtime glucose value.     

Cost-utility of real-time continuous glucose monitoring versus self-monitoring of blood glucose and intermittently scanned continuous glucose monitoring in people with type 1 diabetes receiving multiple daily insulin injections in Denmark

Aims

To determine the cost-effectiveness of the Dexcom G6 real-time continuous glucose monitoring (rt-CGM) system compared with both the self-monitoring of blood glucose (SMBG) and the Abbott FreeStyle Libre 1 and 2 intermittently scanned CGM (is-CGM) devices in people with type 1 diabetes receiving multiple daily insulin injections in Denmark.

Materials and Methods

The analysis was performed using the IQVIA Core Diabetes Model, which associates rt-CGM use with glycated haemoglobin reductions of 0.6% and 0.36% based on data from the DIAMOND and ALERTT1 trials, respectively, compared with SMBG and is-CGM use. The analysis was performed from the payer perspective over a 50-year time horizon; future costs and clinical outcomes were discounted at 4% per annum.

Results

The use of rt-CGM was associated with an incremental gain of 1.37 quality-adjusted life years (QALYs) versus SMBG. Total mean lifetime costs were Danish Krone (DKK) 894 535 for rt-CGM and DKK 823 474 for SMBG, resulting in an incremental cost-utility ratio of DKK 51 918 per QALY gained versus SMBG. Compared with is-CGM, the use of rt-CGM led to a gain of 0.87 QALYs and higher mean lifetime costs resulting in an incremental cost-utility ratio of DKK 40 879 to DKK 34 367 per QALY gained.

Conclusions

In Denmark, the rt-CGM was projected to be highly cost-effective versus both SMBG and is-CGM, based on a willingness-to-pay threshold of 1× per capita gross domestic product per QALY gained. These findings may help inform future policies to address regional disparities in access to rt-CGM.     

Effect of short-term use of a continuous glucose monitoring system with a real-time glucose display and a low glucose alarm on incidence and duration of hypoglycemia in a home setting in type 1 diabetes mellitus

Background

The objective of this study was to examine whether setting the low glucose alarm of a Guardian^® REAL-Time continuous glucose monitoring system (CGMS) to 80 mg/dl for 3 days and providing instructions to users reduce the risk of hypoglycemia under free-living conditions in individuals with type 1 diabetes mellitus (T1DM).

Methods

Fourteen participants with T1DM aged 26.1 ± 6.0 years (mean ± standard deviation) were fitted with a CGMS and assigned for 3 days to either an alarm [low and high blood glucose (BG) alarms set at 80 and 200 mg/dl, respectively] or no alarm condition, with each treatment administered to all participants following a counterbalanced design. All participants were given detailed instructions on how to respond appropriately to low glucose alarms.

Results

The CGMS with alarm reduced the incidence of hypoglycemia (CGMS readings ≤65 mg/dl) by 44% as well as the time spent below this hypoglycemic threshold by 64% without increasing average BG levels. However, the CGMS with alarm had no effect on the incidence of symptomatic hypoglycemia.

Conclusions

Short-term use of the CGMS with alarm, together with appropriate instructions for users, reduces the incidence and duration of hypoglycemia, but only to a limited extent, in part because it overestimates BG in the low glucose range.     

Treatment aims and philosophy in the treatment of adolescent anorexia nervosa in Europe

This study describes the range of service provision and explores differences in treatment approaches and therapeutic aims, in the 12 countries participating in the European Union collaborative COST B6 Adolescent Project into the treatment of adolescent anorexia nervosa (AN). Following a number of group meetings, two questionnaires were administered, completed and returned by e‐mail. The first questionnaire examined features of the services provided, including details of the numbers of patients seen, inpatient admission criteria and aspects of patient management. The second questionnaire contained a list of 13 therapeutic aims, asking respondents to rank in order the six they considered most important in the first weeks of treatment. There was broad agreement between services concerning the need to offer a full spectrum of services in a range of settings. Nevertheless, there were significant differences in approaches, chiefly concerning the readiness to admit to hospital, the use of (individual or family) day units and the focus on weight restoration as opposed to therapeutic engagement. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Continuous glucose monitoring: a review of the evidence,opportunities for future use and ongoing challenges

The advent of devices that can track interstitial glucose levels, which are closely related to blood glucose levels, on a near continuous basis, has facilitated better insights into patterns of glycaemia. Continuous glucose monitoring (CGM) therefore allows for more intensive monitoring of blood glucose levels and potentially improved glycaemic control. In the context of the announcement on 1 April 2017 that the Australian Government will fund CGM monitoring for people with type 1 diabetes under the age of 21 years, this paper provides a review of the evidence for CGM and some of the ongoing challenges. There is evidence that real‐time CGM in type 1 diabetes improves HbA1c and hypoglycaemia, while in type 2 diabetes, the evidence is less robust. Initial barriers to widespread implementation of CGM included issues with accuracy and user friendliness; however, as the technology has evolved, these issues have largely improved. Ongoing barriers include cost, and weaker evidence for their benefit in certain populations such as those with type 2 diabetes and less glycaemic variability. CGM has the potential to reduce healthcare costs, although real‐world studies, including cost‐effectiveness analyses, are needed in this area.