Diabetes and eating disorders: an exploration of ‘Diabulimia'

Abstract: Background: ‘Diabulimia’ is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research. Methods: Forty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis. Results: The average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction. Conclusions: Overall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider

2D:4D digit ratio and types of adult paranormal belief: An attempted replication and extension of Voracek (2009) with a UK sample

This study examines the extent to which mean digit length (MDL), second-to-fourth digit ratio (2D:4D), digit asymmetry (DA) and fluctuating asymmetry (FA) correlate with belief in three types of alleged paranormal phenomena (extrasensory perception, psychokinesis, and life after death). An opportunistic sample of 275 undergraduate students completed standard paranormal belief and demographics questionnaires with the absolute length of their 2D and 4D on both hands measured by participants themselves (direct self-based measures) as well as by two independent from hand photocopies (indirect rater-based measures). As hypothesised, females presented a lower MDL (both measurement sources) but higher indirect rater-based 2D:4D ratio than males. Additionally, females’ left hand 2D:4D correlated positively with their belief in psychokinesis with their right hand 2D:4D correlating with belief in both extrasensory perception and psychokinesis. Females' direct self-based FA was also associated with stronger PK beliefs. These trends did not exist for male participants. Finally, no significant relationships were found between either MDL or DA and any belief type regardless of measurement source, hand or participant sex. Results are discussed in relation to previous work by Voracek (2009) and their support for genetic bio-markers of adult paranormality. Methodological limitations are also considered

Executive functions and the role of dieting: A comparison between English and Greek females

Introduction: This study investigated and compared the effect of dieting status and culture on executive functions (EFs) between English and Greek females. The moderating role of restrained eating, preoccupying cognitions, depressed affect and IQ was also investigated to provide further evidence of the nature of this effect. Methods: A between-subjects design was employed, where 192 females were recruited from UK (n =45) and Greek (n =147) Universities; 99 were current dieters and 93 were non-dieters. The Behavior Rating Inventory of Executive Function (BRIEF-A) was used to assess Executive Functions (EFs). Participants also completed the Dutch Eating Behaviour Questionnaire-Restraint (DEBQ-R), Preoccupying cognitions, Centre for Epidemiologic Studies Depression scale (CESD), Raven's Advanced Progressive Matrices-Set I, and a questionnaire acquiring demographic information. MANOVA and MANCOVA analyses were carried out. Results: There was a significant multivariate main effect for dieting status (P < 0.05) and nationality (P < 0.001). Specifically, dieters self-report greater difficulty on inhibit (P < 0.001), self- and task-monitor, organisation of materials and working memory (P < 0.01), and shift, emotional control, initiate and plan/organise (P < 0.05). A significant univariate effect was found for nationality, in terms of emotional control (P < .0.01), whereby a higher mean T-score was revealed for Greek (M = 62.12; SD = 11.01) compared to English females (M = 59.28; SD =13.95). With DEBQ-R and preoccupying cognition scores entered as covariates, the effect of nationality, on emotional control, remained significant (P < 0.001). However, none of the main effects for dieting status remained significant (P > 0.05). Discussion and Conclusion: Greek females self-report greater difficulty in controlling their emotions. Dieters found to have a poorer ability on the components of EFs; nationality also found to have an effect on EFs. Outcomes of this research provide fruitful implications on the association between dieting, culture and EFs

Diabetes and eating disorders: an exploration of ‘Diabulimia’

From Springer Nature via Jisc Publications RouterHistory: received 2020-06-30, registration 2020-09-17, accepted 2020-09-17, pub-electronic 2020-09-23, online 2020-09-23, collection 2020-12Publication status: PublishedAbstract: Background: ‘Diabulimia’ is the term given to the deliberate administration of insufficient insulin for the purpose of weight loss. Although Diabulimia can be life-threatening and prevalence rates in diabetes are high, there is a lack of research for how to effectively support people with the condition. This exploratory study aimed to provide much-needed information to healthcare professionals and guide the focus for future research. Methods: Forty-five individuals with Type 1 diabetes mellitus (T1DM) and a history of insulin misuse completed an online questionnaire. This included an assessment of their eating disorder psychopathology with the Eating Disorder Examination Questionnaire (EDE-Q) and 16 open-ended questions exploring their experience of Diabulimia. The responses to the open-ended questions were analysed using thematic analysis. Results: The average global EDE-Q score was 3.96 (1.21), which is consistent with eating disorder populations. Common themes identified were concerns about weight, difficulty coping with diabetes, past trauma, and the importance of relationships. Experiences with health professionals were overwhelmingly negative. Most participants had experienced serious medical intervention due to Diabulimia and were fully aware of the consequences of insulin restriction. Conclusions: Overall, individuals believed that a greater awareness of Diabulimia and more training for healthcare professionals is needed. While education on insulin misuse may be a necessary first step in treatment, psychological support is crucial. To deliver effective treatment, clinicians should be aware of the specific issues facing those with Diabulimia. The current study identified themes that clinicians may find useful to consider

Photocopies yield lower digit ratios (2D:4D) than direct finger measurements.

The ratio between 2nd and 4th digit length (2D:4D) may be a negative correlate of prenatal testosterone. This possibility has led to a number of studies of 2D:4D and its relationship with sexual orientation and other sex-dependent traits. At first, 2D:4D ratio was calculated from measurements made directly on the fingers but recently a number of studies have used measurements from photocopies of the hands. Here, we compared finger lengths (2D, 3D, 4D, and 5D) and ratios obtained from these two measurement techniques. Our sample consisted of 30 homosexual men and 50 men and 70 women who were not selected for their sexual orientation. We found evidence that (1) 2D:4D from photocopies tended to be lower than that from direct measurements, (2) there were differences in finger lengths such that 2D from photocopies tended to be shorter or equal in length to direct measurements, while 4D from photocopies tended to be longer or equal in length to direct measurements, (3) the sex differences in 2D:4D tended to be stronger for photocopy measurements, and (4) the pattern for length differences across 2D to 5D appeared to be different for homosexual men compared to men and women recruited without regard to sexual orientation. We conclude that there are differences in digit ratios obtained from photocopies and direct measurements, and these differences arise from length differences recorded from the different protocols. Therefore, 2D:4D ratios obtained from photocopies and direct measurements should not be combined within one study nor should they be used together in comparative studies. We suggest that finger length differences between the two techniques could result from the shapes of fat-pads at the tips of the fingers, and these may be dependent on sex and sexual orientation

Intelligent autonomous treatment of bedwetting using non-invasive wearable advanced mechatronics systems and MEMS sensors

Post-void alarm systems to monitor bed wetting in Nocturnal Enuresis (NE) have been deemed unsatisfactory. The aim in this study is to develop a safe, comfortable and non-invasive pre-void wearable alarm and associated technology using advanced mechatronics. Each stage of development includes patient and public involvement and engagement (PPI). The early stage of the development involved children with and without nocturnal enuresis (NE) (and parents) who were tested at a hospital under the supervision of physicians, radiologists, psychologists, and nurses. The readings were simultaneously compared to B-mode images and measurements, acquired from a conventional ultrasound device, and were found to correlate highly. The results showed that determining imminent voiding need is viable using non-invasive sensors. Following on from "proof of concept", a bespoke advanced mechatronics device has been created. The device houses custom electronics, an ultrasound system, intelligent software, a user-friendly smartphone application, bedside alarm box and a dedicated undergarment, along with a self-adhesive gel pad - designed to keep the MEMS sensors aligned with the abdomen. Testing of the device with phantoms and volunteers has been successful in determining bladder volume and associated voiding need. Five miniaturized, and therefore more ergonomic, versions of the device are being developed, with an enabled connection to the cloud platform for location independent control and monitoring. Thereafter, the enhanced device will be tested with children with NE at their homes for 14 weeks, to gain feedback relating to wearability and data collection involving the cloud platform

Wearable Miniaturised Smart Device For Children With Nocturnal Enuresis

This research was designed to evaluate if it is viable to awaken children with urinary incontinence at the pre-void phase using a smart wearable device and enable them to control incontinence with fine-tuned individual parameters determined by the device intelligently. To address this research question, a miniaturised wearable smart device was built in this multidisciplinary research to monitor the non-linear behaviours of the bladder during its expansion with urine intake. The device, with its customisable abilities, sets an individual alarm point to awaken the child with incontinence before voiding. Safety parameters, aesthetics and ergonomic use of the device were investigated through hospital trials with children and the device was improved based on the obtained feedback from these trials. Clinical Relevance: The device will help children learn how to control their incontinence over time

Patient Engagement in Medical Device Design: Refining the Essential Attributes of a Wearable, Pre-Void, Ultrasound Alarm for Nocturnal Enuresis

Background To date, no pre-void wearable alarm exists to treat nocturnal enuresis (NE)—night-time bedwetting, and children with NE and their families are disappointed in relation to the post-void moisture alarms and medicine currently available. Development of a safe, comfortable and non-invasive wearable pre-void alarm and associated technology, using advanced mechatronics, is underway (the MyPAD device). Each stage of development includes patient and public involvement (PPI), particularly with respect to human factors, in collaboration with physicians, radiologists, psychologists, nurses, engineers and designers. Objectives The aim of this study was to help us understand the families’ experience of the condition of enuresis, and to provide opinion relating to existing NE alarms, designed to detect moisture, and most importantly, the initial design of the MyPAD wearable technology. Methods A PPI workshop in the form of a focus group, made up of children with enuresis and their parents, was conducted during the early stage of the MyPAD product development. The key research questions (RQs) were: (RQ1) What were the families’ experiences of using existing post-void enuresis alarms? (RQ2) What do families like about the MyPAD prototype? and (RQ3) What do families not like about the MyPAD prototype? A nurse specialised in terms of NE treatment, including post-void alarms, from the Lancashire Teaching Hospitals NHS Foundation Trust, and two MyPAD design engineers were also present, to explain the MyPAD design concept. Braun and Clarke’s six-phase approach to thematic analysis was implemented, which included familiarisation with the data, initial descriptive coding, identifying themes, reviewing themes, defining and labelling themes and producing a report. Results Four common themes were identified from the focus group discussions: the importance of sleep; children do not want to feel different; parents feel frustrated and concerned; resilience and perseverance. These themes applied across the research questions; for example, sleep disruption was highlighted as an issue with existing post-void alarms and as an important requirement for the design of MyPAD. The evaluation of the early version of the MyPAD device has prompted the consideration of changes to some existing facets of the device, including providing multiple alarm types, more options for the design of the garment that houses the device, and the need for clear, age-appropriate and informative instructions relating to how the device should be used, in order to maximise its performance/efficiency and acceptance. Conclusions The qualitative data derived from the focus group discussion was incredibly valuable as it enabled the research and design team to experience the perspectives of the families in terms of the challenges and conflicts of managing the condition and the limited utility of existing post-void alarms. This has improved our understanding of the social and environmental challenges that will need to be considered during the design process

A laboratory investigation of stress-induced eating behaviour

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