scholarly journals An open trial of app-assisted acceptance and commitment therapy (iACT) for eating disorders in type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Rhonda M. Merwin ◽  
Ashley A. Moskovich ◽  
Michael Babyak ◽  
Mark Feinglos ◽  
Lisa K. Honeycutt ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Type 1 Diabetes ◽  
Acceptance And Commitment Therapy ◽  
Diabetes Management ◽  
Personal Values ◽  
Psychological Flexibility ◽  
Open Trial ◽  
Diabetes Distress ◽  
Acceptance And Commitment

Abstract Background Eating 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. Methods Adults 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. Results Treatment 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. Conclusions Findings 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 registration NCT02980627. Registered 8 July 2016.

scholarly journals Disturbed Eating Behaviors in Youth with Type 1 Diabetes: An Exploratory Study about Challenges in Diagnosis

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1044
Author(s):  
Valeria Calcaterra ◽  
Chiara Mazzoni ◽  
Donatella Ballardini ◽  
Elena Tomba ◽  
Gian Vincenzo Zuccotti ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Type 1 Diabetes ◽  
Eating Behaviors ◽  
Diabetes Management ◽  
Early Recognition ◽  
Screening Tools ◽  
Effective Prevention ◽  
Eating Problem ◽  
R Factors

Background: Disordered eating behaviors (DEBs), including diagnosable eating disorders, are quite common and can interfere with optimal type 1 diabetes (T1DM) management. We explored DEBs prevalence in youth with T1DM, proposing news diagnostic subscales, to represent the clinical dimensions associated with feeding and eating disorders (ED); Methods: additionally to SCOFF questionnaire and Diabetes Eating Problem Survey–Revised (DEPS-R), four subscales combined from the original DEPS-R questionnaire were administered to 40 youths with T1DM (15.0 ± 2.6); Results: females showed higher scores than males in DEPS-R original factor 2 (“preoccupations with thinness/weight”, p = 0.024) and in DEPS-R proposed “restriction” factor (p = 0.009). SCOFF scores was correlated with original DEPS-R factors 1 (“maladaptive eating habits”) and 2 (p < 0.001) and with the newly proposed DEPS-R factors: restriction, disinhibition, compensatory behaviors, diabetes management (all p < 0.02). Diabetes management was the only factor related to glycated hemoglobin level (p = 0.006). Patients with high DEPS-R score (≥20) scored higher than patients with low (<20) DEPS-R score in DEPS-R original factors 1 (p < 0.001) and 2 (p = 0.002) as well as in the proposed factors including restriction, disinhibition, diabetes management (all p < 0.02); Conclusions: the complicated nature of DEBs calls for the development target specific questionnaires to be used as screening tools to detect cases of DEBs and exclude non cases. Early recognition of DEBs in adolescents with T1DM is essential for effective prevention and successful treatment.

scholarly journals Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Alexandra Monzon ◽  
Nicole Kahhan ◽  
Arwen Marker ◽  
Susana Patton
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Diabetes Distress ◽  
Treatment Needs ◽  
Treatment Groups ◽  
Manualized Treatment ◽  
Fear Of Hypoglycemia ◽  
Psychosocial Concerns ◽  
P Type

UNSTRUCTURED Type 1 diabetes management can be challenging for children and their families. To address psychosocial concerns for parents of youth with type 1 diabetes, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early stages of the COVID-19 pandemic and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents’ treatment needs.

scholarly journals Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes

2017 ◽  
Vol 34 (9) ◽  
pp. 1228-1234 ◽  
Author(s):  
D. M. Hessler ◽  
L. Fisher ◽  
W. H. Polonsky ◽  
U. Masharani ◽  
L. A. Strycker ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Diabetes Distress ◽  
Over Time

scholarly journals ACTonDiabetes—a guided psychological internet intervention based on Acceptance and Commitment Therapy (ACT) for adults living with type 1 or 2 diabetes: results of a randomised controlled feasibility trial

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049238
Author(s):  
Eileen Bendig ◽  
Natalie Bauereiss ◽  
Andreas Schmitt ◽  
Patrick Albus ◽  
Harald Baumeister
Keyword(s):  
Clinical Trials ◽  
Acceptance And Commitment Therapy ◽  
User Feedback ◽  
Feasibility Trial ◽  
Diabetes Distress ◽  
Self Help ◽  
Acceptance And Commitment ◽  
Randomised Controlled

ObjectivesThis two-group randomised controlled trial evaluates the feasibility of an Acceptance and Commitment Therapy (ACT)-based internet intervention for diabetes distress in people with diabetes type 1 or type 2. Participants were assigned to a guided self-help intervention (EG) or waitlist control group (CG).SettingRecruitment took place following an open recruitment strategy including different diabetes centres, self-help groups and social media platforms.ParticipantsEligibility criteria comprised being 18 years of age or older, self-reported diagnosis of type 1 or type 2 diabetes, internet access, sufficient German language skills and written informed consent.InterventionACTonDiabetes is an internet-based and mobile-based intervention and comprises an introduction and seven modules (one module per week, processing time about 45–60 min). Intervention contents are based on ACT.Primary and secondary outcome measuresParticipants were assessed before and 8 weeks after randomisation. Primary outcome was feasibility (trial recruitment, acceptability). Potential group differences in diabetes distress and other outcomes at follow-up were analysed using linear regression models with baseline values as predictors. All analyses were based on an intention-to-treat principle, potential negative effects were analysed on per-protocol basis.ResultsFrom October 2017 to April 2018, N=42 people with diabetes consented and were randomised (EG n=21, CG n=21). Forty-three per cent of the EG completed all treatment modules within 8 weeks. Across modules, formative user feedback revealed that contents could be optimised regarding comprehensibility (34%), individualisation (20%) and text amount (21%). Overall, 57% of participants dropped out prior to full treatment completion. There were reductions of diabetes distress in the EG (d=0.65, p=0.042).ConclusionsModifications of the intervention content according to the user feedback will be performed to further improve acceptability. Mechanisms to foster intervention adherence should be considered for lowering the attrition rate. ACTonDiabetes is feasible for the implementation in a confirmatory trial.Trial registration numberWHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS) (DRKS00013193).

scholarly journals Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022234 ◽  
Author(s):  
Susanne Amsberg ◽  
Ingrid Wijk ◽  
Fredrik Livheim ◽  
Eva Toft ◽  
Unn-Britt Johansson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Acceptance And Commitment Therapy ◽  
Group Intervention ◽  
Controlled Trial ◽  
Swedish Version ◽  
Time Points ◽  
Management Group ◽  
Acceptance And Commitment ◽  
Randomised Controlled

IntroductionIntegrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.Methods and analysisThis study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1cwill be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.Ethics and disseminationThe study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.Trial registration numberNCT02914496; Pre-results.

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