Can guided self-help improve the management of binge eating in adults type 2 diabetes? Results of the POSE-D study

Abstract

People with type 2 diabetes are more likely to experience binge eating than the general population, which may interfere with their diabetes management. Guided Self-Help (GSH) is the recommended treatment for binge eating disorder (1), but there is currently a lack of evidenced treatment for binge eating in individuals living with type 2 diabetes.The aims of this pilot study were to test the feasibility and acceptability of recruiting and delivering a 12-week, online psychological GSH intervention which has been adapted in an earlier study to the needs of adults with T2 diabetes and binge eating (2).The intervention comprises GSH materials presented online in 7-sections delivered over 12-weeks, supported by a trained Guide. In total 22 participants were recruited in a case series design, through GP practices, NHS specialist weight management and diabetes services and via social media. Outcome measures were collected pre and post-intervention and at 12-week follow-up. The primary outcome was the Gormally Binge Eating Scale and secondary outcomes included eating disorder psychopathology, depression, anxiety, quality of life and HBA1C. Following the intervention, we conducted semi-structured interviews with 6 participants and 4 Guides. Data were analysed using a random intercept multi-level model.Results showed at baseline that 67% of the sample met the criteria for moderate to severe binge eating (cut-off (≤17). At post-intervention there was a statistically significant reduction in self- reported binge eating on the Gormally binge eating scale with a reduction in mean score moving from 26.8 to 14.2, (t= -4.181, p < 0.001) and only 9% meeting criteria for binge eating. There were also notable improvements in anxiety, depression and quality of life scores, but not eating disorder psychopathology.In the interviews both Guides and participants found the adapted online platform easy to use and the sessional support sufficient. They highlighted what a large commitment it was and therefore the importance of the Guide and working in ‘partnership’. The intervention appeared particularly suited to ‘stress eaters’, those experiencing ‘severe binge eating’ episodes and physical symptoms of diabetes. As a result of the intervention, participants reported ‘making broader lifestyle changes’, ‘improvements in their diabetes management’ and ‘confidence’. Guides found the training and supervision helpful but reflected on some ‘challenges with engagement’. On ending the intervention, participants requested ‘ongoing support’, such as an optional follow-up appointment and continued access to the materials.In conclusion, the study shows preliminary evidence for online GSH tailored to the needs of individuals with T2D as a promising approach to improving binge eating, diabetes management, mental wellbeing and quality of life, however effectiveness evidence is needed.