Teaching people to eat according to appetite - Does the method of glucose measurement matter?

Michelle R Jospe; Willemijn E de Bruin; Jillian J Haszard; Jim I Mann; Mark Brunton; Rachael W Taylor

doi:10.1016/j.appet.2020.104691

Teaching people to eat according to appetite - Does the method of glucose measurement matter?

Appetite. 2020 Aug 1:151:104691. doi: 10.1016/j.appet.2020.104691. Epub 2020 Apr 1.

Authors

Michelle R Jospe¹, Willemijn E de Bruin², Jillian J Haszard³, Jim I Mann⁴, Mark Brunton⁵, Rachael W Taylor⁶

Affiliations

¹ Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: michelle.jospe@otago.ac.nz.
² Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: w.debruin@otago.ac.nz.
³ Centre for Biostatistics, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: jill.haszard@otago.ac.nz.
⁴ Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: jim.mann@otago.ac.nz.
⁵ Information Technology Services, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: mark.brunton@otago.ac.nz.
⁶ Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. Electronic address: rachael.taylor@otago.ac.nz.

PMID: 32246953
DOI: 10.1016/j.appet.2020.104691

Abstract

Background: Hunger training teaches people to eat according to their appetite using pre-prandial glucose measurement. Previous hunger training interventions used fingerprick blood glucose, however continuous glucose monitoring (CGM) offers a painless and convenient form of glucose monitoring. The aim of this randomised feasibility trial was to compare hunger training using CGM with fingerprick glucose monitoring in terms of adherence to the protocol, acceptability, weight, body composition, HbA1c, psychosocial variables, and the relationship between adherence measures and weight loss.

Methods: 40 adults with obesity were randomised to either fingerpricking or scanning with a CGM and followed identical interventions for 6 months, which included 1 month of only eating when glucose was under their individualised glucose cut-off. For months 2-6 participants relied on their sensations of hunger to guide their eating and filled in a booklet.

Results: 90% of the fingerpricking group and 85% of the scanning group completed the study. Those using the scanner measured their glucose an extra 1.9 times per day (95% CI 0.9, 2.8, p < 0.001) compared with those testing by fingerprick. Both groups lost similar amounts of weight over 6 months (on average 4 kg), were satisfied with the hunger training program and wanted to measure their glucose again within the next year. There were no differences between groups in terms of intervention acceptability, weight, body composition, HbA1c, eating behaviours, or psychological health. Frequency of glucose testing and booklet entry both predicted a clinically meaningful amount of weight loss.

Conclusions: Either method of measuring glucose is effective for learning to eat according to hunger using the hunger training program. As scanning with a CGM encouraged better adherence to the protocol without sacrificing outcome results, future interventions should consider using this new technology in hunger training programs.

Keywords: Acceptability; Adherence; Blood glucose self-monitoring; Continuous glucose monitoring; Food intake regulation; Obesity.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Appetite*
Blood Glucose
Blood Glucose Self-Monitoring*
Humans
Hunger
Weight Loss

Substances

Blood Glucose