Time of Day When Type 1 Diabetes Patients With Eating Disorder Symptoms Most Commonly Restrict Insulin

Merwin, Rhonda M.; Moskovich, Ashley A.; Honeycutt, Lisa K.; Lane, James D.; Feinglos, Mark N.; Zucker, Nancy; Dmitrieva, Natalia O.; Babyak, Michael A.; Batchelder, Heather; Mooney, Jan

doi:10.1097/psy.0000000000000550

Cited by 19 publications

(25 citation statements)

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“…The recruitment target was N = 25, for a final sample of N = 21 with attrition. Assuming two-tailed α = .05, a pre-post mean of average 3-day blood glucose correlation of 0.7, and SD = 58.08 mg/dL (calculated from prior data [ 17 , 31 ], a sample size of 21 provided 80% power to detect a reduction of at least 32 mg/dL in average daily blood glucose, equivalent to a .5% reduction in HbA 1c , which is considered clinically significant [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

“…These settings have the advantage of providing therapeutic support in the moment that individuals are making decisions about their T1D management. A mobile app can similarly provide additional therapeutic support anytime, including in the late afternoon or overnight when individuals may be more prone to skip insulin [ 31 ]. The app was also included to expedite skill acquisition and generalization to daily life (a common obstacle in cognitive behavioral therapy) [ 32 ] and it allowed T1D patients to track daily behavior change goals, rather than relying on distal outcomes, such as HbA 1c .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Previous continuous glucose monitoring (CGM)based studies in type 1 diabetes and disordered eating have shown that insulin omission/restriction is associated with higher post-meal glucose. [17][18][19] Thus, people with disordered eating may experience greater fluctuation in their glucose, which is not reflected in their HbA 1c . This study aimed to characterise glycaemia of people with type 1 diabetes and disordered eating and explore association of these glycaemic changes with emotion and diabetes self-care behaviours.…”

Section: Introductionmentioning

confidence: 99%

Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self‐care behaviour and emotion

et al. 2020

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Objectives Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self‐care behaviour and emotional state of women with type 1 diabetes and disordered eating. Research design and methods In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case–control study. We used a mixed‐methods approach with a 7‐day blinded continuous glucose monitoring and real‐time record of non‐prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann–Whitney U test or Fisher's exact test. We conducted thematic analyses of free‐text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags. Results People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9 mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p = 0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7 mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p = 0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15 mmol/L). Conclusions Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.

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“…Gece ara öğünü için belirlenen net bir zamanın olmayışı, bu konudaki önerileri de karmaşık hale getirmektedir. Genel olarak ana öğünden 2.5-3 saat sonrası ara öğünün başlangıcı olarak kabul edilmektedir (5). Bolus insülin verilmeden tüketilen atıştırmalıklar ve sık ara öğün almak ise glukoz profilinde bozulmaya neden olmaktadır (1,6,7).…”

Section: Introductionunclassified

Tip 1 Diyabetli Okul Öncesi Dönem Çocuklarda Yatmadan Önce Süt İçmenin Gece Glukoz Seyrine Etkisi: Vaka Sunumları

et al. 2020

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Tip 1 diyabet (T1D) tanılı küçük çocuklar diyabet yönetimi ve glisemik değişkenlik bakımından ayrı bir yere sahiptir. Küçük çocuklar (<7 yaş), hipoglisemi ve hipergliseminin daha sık görülmesi, hipoglisemi bulgularını ifade edememeleri, rezidüel beta hücre fonksiyonunun az olması, ciddi hipoglisemi atakları ve kronik hiperglisemiye bağlı uzun dönemde nörokognitif etkilenmenin daha fazla olması gibi birçok zorlukla karşı karşıyadır. Bu zorluklar ebeveynlere endişe olarak yansımakta ve birçok ebeveyn gece hipoglisemisi korkusu nedeniyle glukoz değeri ne olursa olsun rutin bir şekilde çocuğa gece ara öğünü vermektedir. Ülkemizde çocukların gece uyumadan önce ve sabah süt içme alışkanlıkları olması sebebiyle süt sık tüketilen bir seçenek olmaktadır. Kliniğimizde izlenen küçük yaş grubu çocukların Sürekli Glukoz İzlem (SGİ) verilerinde süt içirip uyutmanın gece boyunca hiperglisemiye neden olduğu, süt vermenin bırakılması durumunda ise gece glukoz seyrinin hedef aralıkta (70-180 mg/dL) kalma oranının arttığı gözlenmiştir. Bu yazıda kliniğimizde izlenen 3-5 yaş arasındaki iki olgunun tıbbi beslenme tedavisi ve gece ara öğününde verilen sütün SGİ verilerine yansıması paylaşılacaktır.

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Time of Day When Type 1 Diabetes Patients With Eating Disorder Symptoms Most Commonly Restrict Insulin

Abstract: Findings suggest that insulin restriction may be less likely in the morning, and that late afternoon is a potentially important time for additional therapeutic support. Results also suggest that systematic clinical assessment and treatment of overnight eating might improve T1D management.

Cited by 19 publications

References 13 publications

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

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

Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self‐care behaviour and emotion

Tip 1 Diyabetli Okul Öncesi Dönem Çocuklarda Yatmadan Önce Süt İçmenin Gece Glukoz Seyrine Etkisi: Vaka Sunumları

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