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Type 1 DiabetesNCT05540704

Study Comparing Acceptance and Commitment Therapy to Supportive Diabetes Counseling and a Waitlist Control for Eating Disorders in Type 1 Diabetes

A study testing ACT and Supportive Diabetes Counseling in people with Type 1 Diabetes and Eating Disorders, run by Duke University at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to test whether a new intervention works to treat eating disorders in type 1 diabetes. Participants are assigned to one of the following: (1) Acceptance and Commitment Therapy (ACT), (2) Supportive Diabetes Counseling, or (3) a 6-month Waitlist Control. Read more about this study

Who is it for?
Ages 16 to 50 years
What is being tested?
ACT and Supportive Diabetes Counseling
Could I receive a placebo?
No, everyone receives an active treatment
How many people
235 participants
Where
2 sitesUnited States
Study dates
4 Apr 2023to Sep 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 50 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • 16-50 years of age
  • Diagnosis of Type 1 diabetes
  • Eating disorder characterized by binge eating and/or problematic weight control behaviors, including withholding insulin (Bulimia Nervosa, Binge Eating and Purging Disorder spectrum diagnoses)
  • Independently manages diabetes (not reliant on a caregiver)
  • Expansion Cohort
  • 16-50 years of age
Show all 9Show fewer
  • Diagnosis of Type 1 diabetes
  • DEPR-R score >=20 but does not meet criteria for the primary cohort
  • Primary and Expansion Cohort

Who cannot join

  • Active suicidal ideation
  • Diagnosis of Avoidant Restrictive Food Intake Disorder or Anorexia Nervosa spectrum diagnoses
  • Hypoglycemic unawareness as assessed by the Gold Method and multiple severe episodes of hypoglycemia requiring 3rd party assistance in the last 2 years
  • Current substance abuse disorder or current or past psychotic disorder
  • NonEnglish speaking

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Dottie R Mayo, BA contact

(919) 668-1935

drm72@duke.edu

Rhonda Merwin, PhD contact

(919) 681-7231

rhonda.merwin@duke.edu

United States2 sites, 2 recruiting
  • Duke University

    Durham, North Carolina, 27705

    Dottie R Mayo, BA, 919-668-1935, dorothy.mayo@duke.edu

    Rhonda M Merwin, Ph.D.

    Recruiting
  • Brown University

    Providence, Rhode Island, 02903

    Erica F Robichaud, LCSW, (401) 793-8957, eferguson@lifespan.org

    Jason Lillis, Ph.D.

    Recruiting

Other trials in United States

About this study

Official title: Changing the T1DE (Type 1 Diabetes Eating Disorders): A Randomized Controlled Trial Comparing Acceptance and Commitment Therapy (ACT) to Supportive Diabetes Counseling and a Waitlist Control

The goal of this clinical trial is to test whether a new intervention works to treat eating disorders in type 1 diabetes. Participants are assigned to one of the following: (1) Acceptance and Commitment Therapy (ACT), (2) Supportive Diabetes Counseling, or (3) a 6-month Waitlist Control. Participants in the ACT and Supportive Diabetes Counseling conditions complete 12 sessions over 12-16 weeks and use their mobile phone between sessions to increase engagement and reinforce learning.

The main questions are:

Read more

Does treatment improve glycemic levels, eating disorder symptoms, diabetes management and diabetes distress?

Does one treatment do better than the other?

How do the treatments work, if they work, and for whom?

Participants complete assessments that include wearing a continuous glucose sensor and activity watch, and get a blood draw to determine HbA1c. They also complete diagnostic interviews, surveys and computer tests of attention and things like heart rate and reaction time. These assessments help us better understand the types of changes that are happening and how they might influence health and well-being.

Read the detailed description

This is a randomized controlled trial comparing an Acceptance and Commitment Therapy (ACT) protocol to supportive diabetes counseling (SDC) and a Waitlist Control (WLC) for individuals with type 1 diabetes and disordered eating (or T1DE). Both active conditions are tailored to the needs of individuals living with T1D and the unique conditions under which the eating disorder developed and is maintained. Participants will be 161 individuals with T1D, between the ages of 16-50, with binge-purge eating disorders (EDs), including threshold and subthreshold bulimia nervosa, binge eating disorder and purging disorder. Purging includes restriction of insulin for weight loss. An expansion cohort of 74 persons with T1D and elevated Diabetes Eating Problems Survey-Revised scores (DEPS-R=>20) will also be recruited to assess the utility of the treatments for a broader array of eating and weight control problems in T1D. Participants will be randomized to either ACT, SDC, or a WLC and complete assessments at baseline, mid-treatment, end-of-treatment, and at 1 month, 3 months, and 6 months post-treatment. The primary outcome of interest for power and sample size calculation is blood glucose levels (mean and % time in target glycemic range) as assessed by continuous glucose monitoring. Other outcomes include change in hemoglobin A1c (HbA1c), eating disorder symptoms, diabetes self-management and, secondary, diabetes distress. In addition to examining clinical outcomes, this study tests biobehavioral mechanisms of change and predictors of treatment response. Process of change assessments focus on flexible responding to pathology-relevant stimuli and early improvement in glycemic control affecting executive function. The primary site is Duke University Medical Center. The Miriam Hospital is a secondary site.

Being tested
ACT, Supportive Diabetes Counseling
Keywords
glycemic control, disordered eating behavior, eating disorders, type 1 diabetes, acceptance and commitment therapy, diabetes counseling, mhealth, psychological flexibility
Medical subject headings
Diabetes Mellitus, Type 1, Feeding and Eating Disorders, Disordered Eating Behavior, Binge-Eating Disorder

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ACTBehavioural

    Treatment is based on Acceptance and Commitment Therapy (ACT), a contemporary cognitive behavioral therapy (CBT) that improves human functioning and adaptability by increasing psychological flexibility. Individual therapy sessions are paired with mobile phone delivered interventions.

  • Supportive Diabetes CounselingBehavioural

    Counseling with a diabetes educator knowledgeable about disordered eating in type 1 diabetes. Intervention focuses on supportive listening, diabetes-related education, including management problems and goal setting.

Study groups in NCT05540704
Study groupRoleWhat they receive
Acceptance and Commitment Therapy for Type 1 Diabetes - Eating Disorder (ACT-T1DE)ExperimentalACT-T1DE consists of 12 sessions of flexible ACT protocol tailored to the unique conditions and needs of type 1 diabetes eating disorders. The protocol is based on an initial pilot study (Merwin et al., 2021); however, the current protocol has been modified, based on key stakeholder feedback and to optimize real-world implementation. Modifications include transition from the use of a mobile app to a text messaging platform and a combination of in-person and virtual visits.
Receives: Behavioral: ACT
Supportive Diabetes Counseling (SDC)Active comparatorThe SDC condition is a flexible protocol of 12 sessions consisting of supportive listening, psychoeducation about diabetes and its management and management problems, and goal setting, informed by the ADA Type 1 Diabetes Self-Care Manual and ADCES7 Self-Care Behaviors framework.
Receives: Behavioral: Supportive Diabetes Counseling
6-Month Waitlist ControlNo interventionParticipants assigned to the Waitlist Control complete assessments but do not receive intervention.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in glycemic control as indexed by continuous glucose monitoring (CGM)

    CGM indices of time in target glycemic range, mean blood sugar, frequency of Level 1 and 2 hyperglycemia and blood glucose variability

    Measured: baseline, 6 weeks, 12 weeks, 36 weeks

  2. Change in eating disorder symptoms as indexed by the Diabetes Eating Problems Survey-Revised (DEPS-R)

    Severity of eating and body image concerns, frequency of engagement in maladaptive eating and weight control behaviors, specifically in the context of diabetes. Scores range from 0-80, with higher scores indicating greater symptom severity (worse outcome).

    Measured: baseline, 12 weeks, 16 weeks, 24 weeks, 36 weeks

  3. Change in diabetes self-management as indexed by the Diabetes Self-Management Questionnaire

    Engagement in activities necessary to manage diabetes, including checking blood sugar and administering insulin. Scores range from 0-10 with higher scores indicating better self-management.

    Measured: baseline, 12 weeks, 16 weeks, 24 weeks, 36 weeks

  4. Change in glycemic control as indexed by hemoglobin A1c (HbA1c)

    Glycated hemoglobin (percentage of red blood cells that are glycated providing an estimate of average blood glucose over 3 months)

    Measured: baseline, 24 weeks, 36 weeks

Secondary outcomes (12)
  1. Change in diabetes distress as indexed by the Type 1 - Diabetes Distress Scale

    Feelings of stress or overwhelm with the burden of living with diabetes and diabetes management. Scores range from 1-6, with higher scores indicating greater distress (worse outcome)

    Measured: baseline, 12 weeks, 24 weeks, 36 weeks

  2. CompACT-10

    A 10-item measure of general (rather than diabetes-specific) psychological flexibility. This measure includes component processes of open, aware and engaged, allowing for more in-depth assessment of process of change. This is the primary psychological flexibility measure in the current trial.

    Measured: Baseline, Mid-Treatment, 12 weeks, 16 weeks, 24 weeks, 36 weeks.

  3. Acceptance and Action Diabetes Questionnaire (AADQ)

    Assesses psychological flexibility (process of change) in the context of diabetes specific thoughts and feelings.

    Measured: Baseline, 6 weeks, 12 weeks, 24 weeks, 36 weeks

  4. Valuing Questionnaire (VQ)

    Assesses outcomes expected in an ACT intervention. The VQ consists of 2 Subscales: Values Obstruction and Values Progress. Values Obstruction measures the extent to which thoughts/feelings obstructed engagement in values. Values Progress measures the extent to which an individual made progress in areas of life that are important to them.

    Measured: Baseline, 6 weeks, 12 weeks, 24 weeks, 36 weeks

  5. Executive function

    Computer-administered Stroop and a GoNoGo paradigm. Outcomes of interest are interference or bias score and errors and reaction time (respectively). These measures are included to test the hypothesis that executive function is improved with the improvement of eating disorder symptoms and glycemic control.

    Measured: Baseline, 12 weeks, 36 weeks

  6. High Frequency Heart Rate Variability (HF-HRV)

    Assesses physiological flexibility/adaptability in the presence of emotional stimuli as an exploratory process of change measure.

    Measured: Baseline, 12 weeks, 36 weeks

  7. Actigraphy

    Measures sleep and physical activity as exploratory measures of behavioral mechanisms of change.

    Measured: Baseline, 12 weeks, 36 weeks

  8. Ecological Momentary Assessment (EMA)

    Participants complete questions at home using their mobile phone assessing psychological flexibility, mood, eating and diabetes management behavior, for additional data with high ecological validity. The assessment also aims to test the hypothesis that negative mood is decoupled from problem behavior over the course of treatment.

    Measured: Baseline, 12 weeks, 36 weeks

  9. Change in Eating Disorder Examination - Questionnaire (EDE-Q)

    Self-report version of the Eating Disorder Examination (EDE). The EDE includes a total score and 4 subscale scores: Restraint, Eating Concerns, Weight Concerns, Shape Concerns. It is included to capture aspects of ED not assessed by the DEPS, as well as diagnostic outcome or change.

    Measured: Baseline, 16 weeks, 24 weeks, 36 weeks

  10. GAD-7

    7-Item assessment of anxiety. The primary purpose for inclusion is as a control variable.

    Measured: Baseline, 12 weeks, 36 weeks

  11. PHQ-9

    9-Item assessment of Depression. The primary purpose for inclusion is as a control variable.

    Measured: Baseline, 12 weeks, 36 weeks

  12. T1DE Questionnaire

    This is a 20-item questionnaire developed for the purposes of this trial. The questionnaire is an inventory of target behaviors for individuals with T1DE.

    Measured: Baseline, End-of-Treatment, 3 Months, 6 Months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Sep 2022
  2. Study start4 Apr 2023
  3. Primary completionJun 2027 (estimated)
  4. Study completionSep 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
235 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05540704
Sponsor's protocol ID
Pro00111401
Other IDs
4-SRA-2022-1226-M-B
Status last verified
Sep 2026
First submitted
9 Sep 2022
Last updated
8 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing ACT and Supportive Diabetes Counseling in people with Type 1 Diabetes and Eating Disorders, run by Duke University at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 8 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Dottie R Mayo, BA ((919) 668-1935, drm72@duke.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in glycemic control as indexed by continuous glucose monitoring (CGM) (time frame: baseline, 6 weeks, 12 weeks, 36 weeks). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Sep 2026.

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