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 i ACT, a novel intervention for EDs in T1D grounded in Acceptance and Commitment Therapy (ACT). i ACT was based on the premise that ED symptoms emerge as individuals attempt to cope with T1D and related emotional distress. i ACT 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 i ACT (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 i ACT 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 A 1c also improved, but the p -value did not reach statistical significance, p = .08. Conclusions Findings provide preliminary evidence for i ACT 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.

中文翻译：

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应用程序辅助接受和承诺疗法 (iACT) 针对 1 型糖尿病饮食失调的公开试验


背景 1 型糖尿病 (T1D) 患者的饮食失调 (ED) 会增加早期和严重糖尿病相关并发症以及过早死亡的风险。传统的饮食失调 (ED) 治疗对于 T1D 患者基本上无效，这表明需要根据该患者群体以及出现 ED 症状的独特条件（在需要控制血糖的慢性疾病的背景下）制定治疗方案，饮食和运动）。当前的研究是 i ACT 的试点开放试验，这是一种基于接受和承诺疗法 (ACT) 的针对 T1D 急诊科的新型干预措施。 i ACT 的前提是，当个体试图应对 T1D 和相关情绪困扰时，ED 症状就会出现。 i ACT 教授接受和正念作为适应不良的回避和控制的替代方案，并利用个人价值观来提高参与 T1D 管理的意愿，即使是在令人不安的情况下（例如暴饮暴食后）。在会议之间使用定制的移动应用程序（“应用程序”），以促进个人在做出糖尿病管理决策时应用 ACT 技能。方法 符合 ED 标准的 1D 成人患者完成 12 次 i ACT 疗程（包括 3 次可选的逐渐减量疗程）。除了检查治疗是否可接受和可行（该研究的主要目的）外，该研究还检查了 i ACT 是否与增加的心理灵活性相关（即，在追求个人有意义的价值观的同时，能够对糖尿病产生痛苦的想法/感受） ），以及 ED 症状、糖尿病管理和糖尿病困扰的改善。结果 患有 ED 的 T1D 患者的治疗是可以接受的，并且是可行的。 参与者报告说，与糖尿病相关的想法/感受的心理灵活性有所增加，在追求个人价值观方面的障碍更少，进步更大。从基线到治疗结束，ED 症状、糖尿病自我管理和糖尿病困扰的变化有很大影响（Cohen's d = 0.90-1.79）。血红蛋白 A 1c 也有所改善，但 p 值未达到统计显着性，p = .08。结论 研究结果为 i ACT 改善 1 型糖尿病 ED 患者的预后提供了初步证据，并支持在对照试验中进一步评估该方法。试用注册NCT02980627。 2016 年 7 月 8 日注册。