Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study.
Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study.
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DOI：
10.2196/38479
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发表时间：
2022-12-14
影响因子：
2.2
通讯作者：
Forman, Evan M.
中科院分区：
文献类型：
--
作者：
Juarascio, Adrienne S.;Srivastava, Paakhi;Presseller, Emily K.;Lin, Mandy;Patarinski, G. G.;Manasse, Stephanie M.;Forman, Evan M.
饮食控制是维持暴饮暴食症（BED）和神经性贪食症（BN）患者暴饮暴食的关键因素。减少饮食限制是BN和BED患者认知行为治疗（CBT）的一种改变机制。然而，许多接受CBT的人在治疗期间未能充分减少饮食限制，这可能是由于在日常生活中难以使用治疗技巧（例如，规律饮食）来减少饮食限制。SenseSupport系统是一种新型的即时适应性干预（JITAI）系统，使用连续葡萄糖监测来检测饮食限制期，可以通过提供实时干预来改善CBT，以减少治疗期间的饮食限制。本研究旨在描述SenseSupport的可行性、可接受性和初步评价。我们介绍了一项小型试验的可行性、可接受性、目标参与和初始治疗结局数据，该试验采用ABAB（A=动态血糖监测数据共享和JITAIs-Off，B=动态血糖监测数据共享和JITAIs-On）设计（在整个治疗期间，JITAIs打开2周，然后关闭2周）。参与者（N=30）是基线时每周有≥3次≥5小时不进食的BED或BN发作的个体。参与者接受了12次CBT治疗，并佩戴了连续血糖监测仪，以检测饮食行为并告知JITAI的交付。参与者完成了4项评估，并在整个治疗期间每周报告饮食失调行为，饮食限制和应用程序使用障碍。保留率高（25/30，治疗后83%）。然而，动态血糖监测数据收集率较低（收集了67.4%的预期血糖数据），治疗师和参与者报告了频繁的应用程序相关问题。参与者报告称，SenseSupport系统舒适、干扰最小且易于使用。相对于JITAIs关闭期间，JITAIs开启期间唯一显著更快下降的饮食限制形式是空腹欲望（t43=1.69; P= 0.049; Cohen d=0.25）。与JITAIs关闭期间相比，JITAS开启期间的总体约束力下降趋势更大，但这些结果无统计学显著性（t43=1.60; P= 0.06; Cohen d=0.24）。与JITAIs-Off期间相比，JITAIs-On期间暴饮暴食的频率变化无显著差异（P= 0.23）。从治疗前到治疗后，参与者的暴食（t24=10.36; P<0.001; Cohen d=2.07）、代偿行为（t24=3.40; P= 0.001; Cohen d=0.68）和整体进食病理学（t24=6.25; P<0.001; Cohen d=1.25）均表现出临床显著的大幅下降。本研究描述了第一个干预系统的成功开发和实施，该系统结合了被动连续葡萄糖监测仪和JITAI，以增强暴食型进食障碍的CBT。尽管血糖数据的收集低于预期，但高可接受性和有希望的治疗结局表明，SenseSupport系统需要通过未来的完全有效的临床试验进行额外研究。ClinicalTrials.gov NCT 04126694; https://clinicaltrials.gov/ct2/show/NCT04126694
Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. This study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). Participants (N=30) were individuals with BED or BN engaging in ≥3 episodes of ≥5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. Retention was high (25/30, 83% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. This study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. ClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT04126694
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影响因子：
1.7
作者：
Murphy, Rebecca;Straebler, Suzanne;Fairburn, Christopher G.
通讯作者：
Fairburn, Christopher G.
影响因子：
16.2
作者：
Dassau, Eyal;Bequette, B. Wayne;Doyle, Francis J., III
通讯作者：
Doyle, Francis J., III
DOI：
10.1002/14651858.cd000562.pub3
发表时间：
2009-10-07
期刊：
The Cochrane database of systematic reviews
影响因子：
--
作者：
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通讯作者：
Kashyap, Priyanka
影响因子：
5.5
作者：
Roberto, Christina A.;Grilo, Carlos M.;White, Marney A.
通讯作者：
White, Marney A.
影响因子：
2.6
作者：
Barakat, Sarah;Maguire, Sarah;Touyz, Stephen
通讯作者：
Touyz, Stephen