Using Continuous Glucose Monitoring to Detect and Intervene on Maintenance Factors for Transdiagnostic Binge Eating Pathology

使用连续血糖监测来检测和干预跨诊断性暴食病理学的维持因素

• 批准号: 10023279
• 负责人: ADRIENNE SARAH JUARASCIO
• 金额: $ 43.41万
• 依托单位: PROMPTWORKS, LLC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-24 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10023279
• 关键词: Accountability; Adherence; Adoption; Aftercare; Algorithm Design; Algorithms; Award; Binge Eating; Binge eating disorder; Bulimia; Clinical; Clinical Trials; Cognitive Therapy; Collection; Consumption; Data; Data Collection; Dietary Practices; Disease; Eating; Eating Behavior; Eating Disorders; Evaluation; Goals; Health Personnel; Hour; Individual; Intervention; Link; Literature; Maintenance; Manuals; Meta-Analysis; Methods; Monitor; Motivation; Notification; Patients; Pattern; Pennsylvania; Persons; Phase; Phase II Clinical Trials; Positioning Attribute; Records; Recurrence; Research; Risk Factors; Schedule; Sensitivity and Specificity; Small Business Technology Transfer Research; Symptoms; System; Testing; Therapeutic; Time; Treatment Protocols; Treatment outcome; United States; Universities; Validation; Vomiting; Work; base; clinically significant; data sharing; design; dietary restriction; eating pathology; effective therapy; experience; glucose monitor; improved; improved outcome; innovation; mHealth; member; monitoring device; product development; restrictive eating; success; systematic review; tool; treatment program

PROJECT SUMMARY Although CBT is an effective treatment for many individuals with transdiagnostic binge eating, recent systematic reviews and meta-analyses have found that 40-50% of patients with binge eating disorder (BED) and nearly 70% of patients with bulimia nervosa (BN) remain fully or partially symptomatic after a full course of CBT. Reducing rigid dietary restriction is one of the only mechanisms of action that has been consistently identified in treatments for binge eating. In particular, adherence to a regular eating schedule (e.g. eating three meals and one-two snacks per day and not going more than four waking hours without eating) is one of the biggest predictors of treatment success in both BN and BED. Although one of the primary goals of CBT for binge eating is the reduction of dietary restriction (with over 50% of session content dedicated to this goal in most treatment manuals), many patients continue to engage in restrictive eating behaviors during and after treatment, suggesting that CBT is failing to sufficiently improve this clinical target. This pattern of results suggests a critical need both to understand why many individuals fail to improve in existing treatments and to develop new intervention approaches or augmentations that can produce superior treatment outcomes. The primary goal of this STTR Phase 1 application is to develop and pilot an mHealth intervention system (SenseSupport) that can be used as an augmentation to traditional CBT for transdiagnostic binge eating that can better target dietary restriction. Our proposed mHealth intervention system will use continuous glucose monitoring (CGM) to 1) accurately detect dietary restriction as it occurs, 2) accurately detect known risk-factors for a reoccurrence of dietary restriction (e.g. binge eating and self-induced vomiting episodes), 3) deliver real- time push notifications linked to brief CBT-based interventions when dietary restriction, binge eating, or self- induced vomiting is detected, and 4) share objective data on eating behaviors with a treatment provider to enhance the therapeutic work occurring during in-person CBT. In months 0-6, we will collect data from 30 individuals with clinically significant binge eating who will wear a Dexcom G6 CGM for four weeks while electronically tracking all eating behaviors and disordered eating symptoms. While data collection is ongoing, we will also use months 0-6 to the SenseSupport system. During months 7-24, we will conduct a small (n=30) clinical trial using an ABAB design (A= SenseSupport On, B=SenseSupport Off) to test the feasibility, acceptability, and target engagement of the SenseSupport System. Receipt of this award will allow members of PromptWorks, Drexel University, the University of Pennsylvania, and Dexcom to develop an innovative intervention system that we believe can reduce dietary restriction and improve treatment outcomes for individuals with clinically significant binge eating. The proposed system would be the first of its kind for the treatment of eating pathology with high potential to market to the over 42 million individuals who experience clinically significant binge eating in the United States as well as to treatment facilities that could use our tool as a way to augment existing treatment approaches.

项目概要 尽管 CBT 对于许多患有跨诊断暴食症的人来说是一种有效的治疗方法，但最近的系统性研究 回顾和荟萃分析发现，40-50% 的暴食症 (BED) 患者和近乎 70% 的神经性贪食症 (BN) 患者在整个 CBT 疗程后仍保持全部或部分症状。 减少严格的饮食限制是已被一致确定的唯一作用机制之一。 暴饮暴食的治疗方法。特别是，坚持有规律的饮食计划（例如三餐和 每天一到两份零食，并且不吃东西的时间不要超过醒着的四个小时）是最大的一项 BN 和 BED 治疗成功的预测因素。尽管 CBT 治疗暴饮暴食的主要目标之一 是减少饮食限制（在大多数治疗中，超过 50% 的课程内容致力于此目标） 手册），许多患者在治疗期间和治疗后继续进行限制性饮食行为， 这表明 CBT 未能充分改善这一临床目标。这种结果模式表明了一个关键的 既需要了解为什么许多人无法改善现有的治疗方法，又需要开发新的治疗方法 可以产生更好治疗效果的干预方法或增强措施。 STTR 第一阶段应用的主要目标是开发和试点移动医疗干预系统 (SenseSupport) 可用作传统 CBT 的增强，用于跨诊断暴食 可以更好地针对饮食限制。我们提出的移动医疗干预系统将使用连续血糖 监测 (CGM) 1) 准确检测发生的饮食限制，2) 准确检测已知的风险因素 对于再次出现饮食限制（例如暴饮暴食和自我诱导呕吐），3）提供真实的 当饮食限制、暴饮暴食或自我控制时，与基于 CBT 的简短干预措施相关的时间推送通知 检测到诱发呕吐，并且 4) 与治疗提供者分享有关饮食行为的客观数据，以 加强面对面 CBT 期间发生的治疗工作。在第 0-6 个月，我们将收集 30 个数据 患有临床显着暴食症的个体将佩戴 Dexcom G6 CGM 四个星期，同时 以电子方式追踪所有饮食行为和饮食失调症状。在数据收集正在进行的同时， 我们还将使用 SenseSupport 系统的 0-6 个月。在第 7-24 个月期间，我们将进行一次小型 (n=30) 使用 ABAB 设计（A= SenseSupport On，B=SenseSupport Off）的临床试验来测试可行性， SenseSupport 系统的可接受性和目标参与度。获得此奖项将使成员 PromptWorks、德雷克塞尔大学、宾夕法尼亚大学和 Dexcom 共同开发一种创新型 我们相信干预系统可以减少饮食限制并改善治疗结果 具有临床意义的暴饮暴食的个体。拟议的系统将是第一个此类系统 饮食病理治疗具有很大的市场潜力，可向超过 4200 万患有此病的人推销 在美国有临床意义的暴饮暴食以及可以使用我们的工具作为治疗设施 一种增强现有治疗方法的方法。

项目成果

Change in adaptive and maladaptive exercise and objective physical activity throughout CBT for individuals with eating disorders.

• DOI: 10.1007/s40519-023-01566-z
• 发表时间: 2023-04-20
• 期刊: EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY
• 影响因子: 2.9
• 作者: Wons, Olivia;Lampe, Elizabeth;Patarinski, Anna Gabrielle;Schaumberg, Katherine;Juarascio, Adrienne
• 通讯作者: Juarascio, Adrienne

Perceived influence of wearable fitness trackers on eating disorder symptoms in a clinical transdiagnostic binge eating and restrictive eating sample.

• DOI: 10.1007/s40519-022-01466-8
• 发表时间: 2022-12
• 期刊: EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY
• 影响因子: 2.9
• 作者: Wons, Olivia;Lampe, Elizabeth;Patarinski, Anna Gabrielle;Schaumberg, Katherine;Butryn, Meghan;Juarascio, Adrienne
• 通讯作者: Juarascio, Adrienne