STEADY Intervention Improves Mental Health Outcomes for Diabetes, Disordered Eating

In a feasibility study, investigators found that improving mental health outcomes for patients with type 1 diabetes and mild-to-moderate disordered eating is possible without deteriorating glycemic control.¹

Eating disorders are more common among women with diabetes compared with women who do not have diabetes. | Image Credit: Monkey Business | stock.adobe.com

Eating disorders are more common among women with diabetes compared with women who do not have diabetes, according to the American Diabetes Association. Patients with type 1 diabetes are reported to be twice as likely to suffer from disordered eating, but there is not data on disordered eating for males with type 1 diabetes. Bulimia is the most common for women with type 1 diabetes.²

The focus on food that comes with diabetes management can make disordered eating difficult to detect and this population more susceptible, according to a study published in 2013 in Current Diabetes Report. Common disordered eating includes anorexia nervosa, which is the refusal to maintain a minimally normal body weight and intense fear of weight gain, and bulimia nervosa, which is repeat episodes of binge eating followed by inappropriate compensatory behaviors. The omission of insulin or restriction of insulin can be used as another way to control weight, which is harmful for those with diabetes.³

The STEADY intervention in the current study was developed to offer outpatient cognitive behavioral therapy and focused intervention for those that have mild-to-moderate type 1 diabetes and disordered eating, which can be delivered by a trained diabetes health care professional. The trial was a double-arm, open-label study that compared the STEADY intervention with usual care. Investigators included patients 18 years and older with established type 1 diabetes of 6 or more months who were experiencing disordered eating or an eating disorder. Forty individuals were assigned 1 to 1 to either group.¹

Patients in the STEADY group received up to 12 sessions of type 1 diabetes and disordered eating cognitive behavioral therapy delivered by a diabetes specialist nurse. The routine also included diabetes care and eating disorder care with the usual care teams. STEADY included diabetes education and diabetes cognitive behavioral therapy with disordered eating modules. The primary outcome included feasibility of delivering the STEADY intervention, including recruitment and attrition rates. Secondary outcomes included biomedical measures, including hemoglobin A­_1c, time in range, and acute diabetes complication rates, and psychometric measures. Safety and adverse event data were collected as well.¹

The primary outcome of the feasibility of the intervention was met, with a recruitment rate of 40.81% and dropout rate of 12.5% in the STEADY group and 10% in the control group at 6 months. For the secondary analysis, hemoglobin A_1c did not differ between the groups, and there was 1 admission of diabetic ketoacidosis in each group with no severe hypoglycemia episodes. There was also no difference for time in range. As for psychometric measures, those in the STEADY group had significantly lower Generalized Anxiety Disorder scores compared with the usual care group and higher DAWN2 Impact of Diabetes Profile scores, indicating lower anxiety and higher quality of life.¹

References

1. Stadler M, Zaremba N, Harrison A, et al. Safety of a co-designed cognitive behavioural therapy intervention for people with type 1 diabetes and eating disorders (STEADY): a feasibility randomised controlled trial. Lancet Reg Health Eur. 2025;50:101205. Published 2025 Jan 20. doi:10.1016/j.lanepe.2024.101205

2. American Diabetes Association. Types of Eating Disorders. Accessed March 7, 2025. https://diabetes.org/health-wellness/mental-health/eating-disorders

3. Hanlan ME, Griffith J, Patel N, Jaser SS. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr Diab Rep. Published online September 12, 2013. doi:10.1007/s11892-013-0418-4