Comprehensive assessment and response for eating disorders in type 1 diabetes (care T1D)

The National Institute of Diabetes and Digestive and Kidney Diseases awarded The Miriam Hospital $111,750 on May 5, 2026, under the Diabetes, Digestive, and Kidney Diseases Extramural Research program (CFDA 93.847) to refine and test an evidence-based healthcare provider training program specific to eating disorder assessment and management in adolescents and young adults with Type 1 Diabetes.

Approximately one-third of adolescents and young adults with Type 1 Diabetes develop eating disorders, and roughly 40 percent engage in dangerous insulin manipulation for weight loss. Left untreated, disordered eating can lead to diabetic ketoacidosis, nephropathy, retinopathy, and death. National and international diabetes medical associations recommend frequent screening for disordered eating risk in pediatric endocrinology clinics, yet most diabetes providers do not screen for these symptoms or risk factors. Diabetes healthcare providers lack training and confidence to evaluate disordered eating in their practices, and patients with comorbid Type 1 Diabetes and eating disorders have expressed need for providers to better understand their condition.

The award funds adaptation of an existing evidence-based pediatric healthcare provider training program to address this critical gap in clinical care. The project team comprises experts in pediatric endocrinology, eating disorders specific to Type 1 Diabetes, adolescent and young adult behavior change, and healthcare provider training. Work is performed in Providence, Rhode Island, with a period of performance through April 30, 2028.

Abstract

Nearly one-third of adolescents and young adults (ayas) with type 1 diabetes (T1D) will develop an eating disorder and approximately 40% will engage in dangerous manipulation of their insulin for weight loss purposes. Left untreated, disordered eating behaviors can lead to significant negative health outcomes such as diabetic ketoacidosis, nephropathy, retinopathy, and death. This issue is so dangerous and prevalent, that national and international diabetes medical associations recommend frequent screening of disordered eating risk in pediatric endocrinology clinics. Yet, the majority of diabetes providers do not screen for disordered eating symptoms and risk factors, leaving patients without any support or intervention. Recent literature has determined that diabetes healthcare providers who treat ayas with T1D lack the training and assurance to evaluate disordered eating in their practices. Further, patients with T1D and comorbid eating disorders have expressed the need for healthcare providers to have a better understanding of their condition to improve trust and care. To the best of our knowledge, no training program currently exists for healthcare providers about eating disorder assessment and treatment specific to ayas with T1D. Our proposed team comprises of experts in pediatric endocrinology, eating disorders specific to T1D, AYA behavior change, and healthcare provider training. Our team is currently adapting an evidence-based, pediatric, healthcare provider training program for ayas with T1D to fill this critical GAP in the literature and clinical care. Thus, the aim of this R03 small grant program is to refine and test an adapted, evidence-based healthcare provider training specific to providers who treat ayas with T1D for eating disorder assessment and management in clinical practice. In the first year of the project, our team will continue to adapt and refine the training program based on qualitative feedback from healthcare providers who treat ayas with T1D and patients with T1D and a history of disordered eating. Results will provide initial acceptability of the training program prior to piloting the intervention. Year two of the project will test the provider intervention using a single-arm open-trial research design. We will evaluate the feasibility (i.e., attendance rates) and acceptability (i.e., validated acceptability measures) of the training program. We will also examine healthcare providers' self-efficacy, competency, and engagement in the assessment of disordered eating behaviors among ayas with T1D before and after completing the refined training program. We hypothesize that the healthcare training program will be feasible, acceptable, and lead to improved provider knowledge, self-efficacy, and assessment of eating disorders among ayas with T1D in their clinics. The results of this study will fill a critical GAP in patient care by providing a clear pathway for early identification and support of AYA patients with T1D who engage in disordered eating behaviors. Further, the results will provide additional pilot data for a larger application to test the outcomes of this pilot study in a randomized controlled trial using more objective outcomes.