Abstract
BackgroundEating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death. Conventional eating disorder (ED) treatments have been largely ineffective for T1D patients, indicating the need to tailor treatments to this patient population and the unique conditions under which ED symptoms emerge (in the context of a chronic illness with unrelenting demands to control blood glucose, diet and exercise). The current study was a pilot open trial of iACT, a novel intervention for EDs in T1D grounded in Acceptance and Commitment Therapy (ACT). iACT was based on the premise that ED symptoms emerge as individuals attempt to cope with T1D and related emotional distress. iACT taught acceptance and mindfulness as an alternative to maladaptive avoidance and control, and leveraged personal values to increase willingness to engage in T1D management, even when it was upsetting (e.g., after overeating). A tailored mobile application (“app”) was used in between sessions to facilitate the application of ACT skills in the moment that individuals are making decisions about their diabetes management.MethodsAdults with T1D who met criteria for an ED completed 12 sessions of iACT (with three optional tapering sessions). In addition to examining whether treatment was acceptable and feasible (the primary aim of the study), the study also examined whether iACT was associated with increased psychological flexibility (i.e., the ability to have distressing thoughts/feelings about diabetes while pursuing personally meaningful values), and improvements in ED symptoms, diabetes management and diabetes distress.ResultsTreatment was acceptable to T1D patients with EDs and feasible to implement. Participants reported increased psychological flexibility with diabetes-related thoughts/feelings, and less obstruction and greater progress in pursuing personal values. There were large effects for change in ED symptoms, diabetes self-management and diabetes distress from baseline to end-of-treatment (Cohen’s d = .90–1.79). Hemoglobin A1c also improved, but the p-value did not reach statistical significance, p = .08.ConclusionsFindings provide preliminary evidence for iACT to improve outcomes for T1D patients with EDs and support further evaluation of this approach in a controlled trial.Trial registrationNCT02980627. Registered 8 July 2016.
Highlights
Eating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death
The current study suggests that a larger study is needed comparing this treatment to a waitlist or to other, currently available interventions
Thirtynine percent of the sample (n = 11) reported using an insulin pump as their mode of insulin delivery, rather than multiple daily injections, which has been associated with lower hemoglobin A1c (HbA1c) [48]
Summary
Eating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death. Individuals with T1D survive by self-monitoring blood glucose and administering insulin multiple times a day to attempt to achieve near-normal glycemia. It is a complex and burdensome regimen that requires careful planning of diet, exercise and insulin dosing to prevent immediately life-threatening circumstances and slow the progression of macro- and microvascular complications and premature death [1, 2]. The cumulative probability of ED onset was 60% by age 25 [4] This is consistent with other studies that have found elevated rates of eating disorders (EDs) and disordered eating behavior among young women with T1D (e.g., [5, 6])
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