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.

项目摘要 尽管CBT对于许多经诊断暴饮暴食的人来说是一种有效的治疗方法 评论和荟萃分析发现，有40-50％的暴饮暴食障碍患者（床）和几乎 全面的CBT疗程后，有70％的神经性贪食症（BN）患者完全或部分症状。 减少严格的饮食限制是始终确定的唯一行动机制之一 暴饮暴食的治疗方法。特别是，遵守定期饮食时间表（例如吃三顿饭和 每天一二个小吃，不吃饭的小时不超过四个小时）是最大的 BN和BED的治疗成功预测因素。虽然CBT的主要目标是暴饮暴食 是减少饮食限制（在大多数治疗中，超过50％的会话内容用于此目标 手册），许多患者在治疗期间和后继续从事限制性饮食行为， 表明CBT无法充分改善该临床目标。这种结果模式表明一个关键 两者都需要了解为什么许多人在现有治疗中无法改善并发展新的人 干预方法或增强方法可以产生卓越的治疗结果。 该STTR 1阶段应用的主要目标是开发和试行MHealth干预系统 （感官）可以用作传统CBT的增强传统CBT，用于转诊暴饮暴食 可以更好地针对饮食限制。我们提出的MHealth干预系统将使用连续的葡萄糖 监测（CGM）至1）准确检测到饮食限制时，2）准确检测已知的风险因素 对于饮食限制的重新发生（例如，暴饮暴食和自我引起的呕吐事件），3） 饮食限制，暴饮暴食或自我的时间推动通知与简短的基于CBT的干预措施有关 检测到诱导的呕吐，4）与治疗提供商共享有关饮食行为的客观数据 增强在面对面CBT期间发生的治疗工作。在0-6月，我们将收集30个数据 患有临床意义的暴饮暴食者，他们会在四个星期内穿dexcom g6 cgm 以电子方式跟踪所有饮食行为和无序饮食症状。当数据收集正在进行中， 我们还将在SenseSupport系统中使用0-6个月。在7-24个月中，我们将进行一个小的（n = 30） 使用ABAB设计（a = senseSupport，b = senseSupport Off）的临床试验，以测试可行性， 可接受性和目标支持系统的目标参与。该奖项的收到将允许 促进工作，Drexel大学，宾夕法尼亚大学和Dexcom开发创新的 我们认为可以减少饮食限制并改善治疗结果的干预系统 患有临床意义的暴饮暴食者。提议的系统将是同类系统中的第一个 对超过4200万个人推销的饮食病理的治疗 在美国，临床意义的暴饮暴食以及可以将我们的工具用作的治疗设施 一种增加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