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Articles by J. H. DeVries
Total Records ( 3 ) for J. H. DeVries
  J. Hermanides , K. Norgaard , D. Bruttomesso , C. Mathieu , A. Frid , C. M. Dayan , P. Diem , C. Fermon , I. M. E. Wentholt , J. B. L. Hoekstra and J. H. DeVries
  Aims  To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes.

Methods  In this investigator-initiated multi-centre trial (the Eurythmics Trial) in eight outpatient centres in Europe, we randomized 83 patients with Type 1 diabetes (40 women) currently treated with multiple daily injections, age 18-65 years and HbA1c≥ 8.2% (≥ 66 mmol/mol) to 26 weeks of treatment with either a sensor-augmented insulin pump (n = 44) (Paradigm® REAL-Time) or continued with multiple daily injections (n = 39). Change in HbA1c between baseline and 26 weeks, sensor-derived endpoints and patient-reported outcomes were assessed.

Results  The trial was completed by 43/44 (98%) patients in the sensor-augmented insulin pump group and 35/39 (90%) patients in the multiple daily injections group. Mean HbA1c at baseline and at 26 weeks changed from 8.46% (sd 0.95) (69 mmol/mol) to 7.23% (sd 0.65) (56 mmol/mol) in the sensor-augmented insulin pump group and from 8.59% (sd 0.82) (70 mmol/mol) to 8.46% (sd 1.04) (69 mmol/mol) in the multiple daily injections group. Mean difference in change in HbA1c after 26 weeks was −1.21% (95% confidence interval -1.52 to -0.90, < 0.001) in favour of the sensor-augmented insulin pump group. This was achieved without an increase in percentage of time spent in hypoglycaemia: between-group difference 0.0% (95% confidence interval -1.6 to 1.7, = 0.96). There were four episodes of severe hypoglycaemia in the sensor-augmented insulin pump group and one episode in the multiple daily injections group (= 0.21). Problem Areas in Diabetes and Diabetes Treatment Satisfaction Questionnaire scores improved in the sensor-augmented insulin pump group.

Conclusions  Sensor augmented pump therapy effectively lowers HbA1c in patients with Type 1 diabetes suboptimally controlled with multiple daily injections.

  L. A. Gonder-Frederick , K. A. Vajda , K. M. Schmidt , D. J. Cox , J. H. DeVries , O. Erol , K. Kanc , H. Schachinger and F. J. Snoek


The Hypoglycemia Fear Survey (HFS)-II Behaviour and Worry subscales were developed to measure behaviours and anxiety related to hypoglycaemia in diabetes. However, previous studies found lower reliability in the HFS Behaviour subscale and inconsistent relationships with glucose control. The purpose of this study was to conduct extensive analyses of the internal structure of the HFS Behaviour subscale's internal structure and its relationships with diabetes outcomes, including HbA1c and episodes of severe hypoglycaemia.


HFS-II survey data from 1460 adults with Type 1 diabetes were collected from five countries. This aggregated sample underwent exploratory factor analysis and item analysis to determine the internal structure of the survey and subscales.


A three-factor solution showed the best fit for the HFS, with two subscales emerging from the HFS Behaviour representing tendencies towards (1) maintenance of high blood glucose and (2) avoidance of hypoglycaemic risks by other behaviours, and a third single HFS Worry subscale. Subscale item analysis showed excellent fit, separation and good point-measure correlations. All subscales demonstrated acceptable (0.75) to excellent (0.94) internal reliability. HbA1c correlated with Maintain High Blood Glucose subscale scores, r = 0.14, P < 0.001, and severe hypoglycaemia frequency correlated with all subscales.


The HFS Worry subscale measures one construct of anxiety about various aspects of hypoglycaemia. In contrast, the HFS Behaviour subscale appears to measure two distinct aspects of behavioural avoidance to prevent hypoglycaemia, actions which maintain high blood glucose and other behaviours to avoid hypoglycaemic risk. These results demonstrate the clinical importance of the HFS Behaviour subscales and their differential relationships with measures of diabetes outcome such as HbA1c.

  L. Heinemann and J. H. DeVries
  Evidence for continuous glucose monitoring is mounting. Meta-analyses consistently show lowering of HbA1c, and the first trial reporting a reduction in severe hypoglycaemic events in patients with hypoglycaemia unawareness has recently been presented. The more recent trials studied larger numbers of patients and may have shown better results because of improved technology. The various combinations of pump and sensor, with automated bolus calculators and low glucose suspend features, make evaluation more challenging from a reimbursement point of view, but evidence seems convincing enough to justify reimbursement for selected patient groups, including those who have shown a substantial improvement in HbA1c during a trial period, and those with hypoglycaemia unawareness who encountered severe hypoglycaemia in the recent past. More data on cost-efficacy are needed.
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