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Title: The eating behaviours, quality of life and cardiometabolic risks of adults with type 1 diabetes using continuous subcutaneous insulin infusion therapy
Author: Webb, R. J.
ISNI:       0000 0004 6059 3573
Awarding Body: Liverpool John Moores University
Current Institution: Liverpool John Moores University
Date of Award: 2017
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Evidence suggests continuous subcutaneous insulin infusion (CSII) is an effective method of achieving glycaemic control in those with Type 1 diabetes (T1D). Among the advantages of CSII is the opportunity for patients to potentially discard the dietary inflexibility imposed by other regimes such as multiple daily injections (MDI). There are also reported improvements in quality of life. Furthermore, patients with T1D who achieve good glycaemic control may present a normal quantitative lipid profile; however, various qualitative atherogenic lipid abnormalities may exist, potentially leading to increased cardiometabolic (CM) risks. Literature investigating this in those using CSII is sparse and frequently dated; as is evidence regarding their eating behaviours and quality of life and is therefore worthy of further research. To investigate these issues an initial audit of CSII patients’ medical records spanning 8 years was performed, with a focus on routinely measured clinical markers of risk (n = 260). Then a cross-sectional study was carried out to compare those using CSII (n = 40) vs. MDI (n = 40). This involved the use of a food diaries and food frequency questionnaires to determine eating behaviours; semi-structured interviews and questionnaires were used to ascertain quality of life and CM risks were assessed by further interrogating participants’ medical records and analysing a sample of plasma for lipoprotein quality. Finally, using similar methods, longitudinal case studies (n = 5) were performed to elucidate the transition from MDI onto CSII over one year. The results indicated that upon commencing CSII HbA1c was significantly reduced from 8.3 to 7.6% (p = < 0.001) and insulin dose significantly lowered from 54.5 to 46.4 IU (p = < 0.001) after using CSII for 12 months and these improvements were maintained over the following 3 years. There were few changes in both quantitative and qualitative lipids; however, systolic blood pressure decreased significantly and unexpectedly both over the 4 year audit period (128.2 to 122.1 mmHg; p = 0.003) and when comparing those using CSII against their MDI counterparts (123.5 mmHg vs. 135.3 mmHg; p = 0.023). Significant reductions were also shown in diastolic blood pressure (75.2 to 72.0 mmHg; p = 0.027). There was little variance in the diets of the two treatment groups; however, subtle differences existed and the intake of certain nutrients such as fibre and iron in females failed to meet the RNI. Many qualitative themes emerged from the interviews regarding participants’ quality of life and in particular highlighted how the device was largely held in positive regard for its ability to improve glycaemic control and offer unprecedented flexibility which allowed a largely unrestricted lifestyle. Despite limitations, this study offers useful information for those working in the field, allowing, for the first time, a deep insight into the eating behaviours, cardiometabolic risks and quality of life of a group of patients using contemporary CSII therapy. It is hoped these findings will assist with decision making processes in clinical practice, thus improving the lives of those with T1D.
Supervisor: Abayomi, J. C. ; Davies, I. G. ; Sparkes, A. C. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: QH301 Biology ; RA0421 Public health. Hygiene. Preventive Medicine