Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals with Binge Eating: The SenseSupport Study (Preprint)

Abstract

Dietary restraint is a key factor that maintains engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a key mechanism of change in cognitive-behavioral therapy (CBT) for BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps due to difficulty utilizing treatment skills to reduce dietary restraint as they go about their daily life. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that utilizes continuous glucose monitoring to detect periods of dietary restraint, may improve upon CBT to reduce dietary restraint during treatment by providing real-time interventions.

The present article describes the development and initial evaluation of SenseSupport. We present feasibility, acceptability, target engagement, and initial treatment outcomes data from a small trial utilizing an ABAB design (in which JITAIs were turned on for two weeks and then turned off for two weeks throughout treatment).

Participants (N = 30) were individuals with BED or BN engaging in at least three 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 delivery of JITAIs. Participants completed four assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment.

Retention was high (83% at post-treatment). However, rates of CGM data collection were low (67.3% of expected glucose data was 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 desire for an empty stomach (t = 1.69, p = .049, d = 0.25), although there was also a trend-level greater decrease in overall restraint during JITAs-on periods compared to JITAIs-Off periods (t = 1.60, p = .06, d = 0.24). There was no significant difference in change in frequency of binge eating during JITAIs-On periods compared to JITAIs-Off periods (p = .23). Participants demonstrated clinically significant, large decreases in binge eating (t = 10.36, p = <.001, d = 2.07), compensatory behaviors (t = 3.40, p = .001, d = 0.68), and global eating pathology (t = 6.25, p <.001, d = 1.25) from pre- to post-treatment.

The present study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs as an augmentation to CBT for binge-spectrum eating disorders. Despite lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest the SenseSupport system warrants additional study in future fully powered clinical trials.

Clinicaltrials.gov identifier NCT04126694.