AIMS:The objective of this study was to evaluate the Diabetes Eating Problems Survey-Revised (DEPS-R) against the Eating Disorder Diagnostic Interview (EDDI). Specific aims were to (1) assess the ability of the DEPS-R to identify Diagnostic and Statistical Manual-5 (DSM-5) eating disorders, including sensitivity and specificity of the current DEPS-R cutoff ≥20 and (2) report the correlation of each item to the presence of any eating disorder. METHODS:Baseline data from 293 women (14-35 years) with type 1 diabetes (T1D) and body image concerns enrolled in a multinational randomized controlled trial were examined. Receiver operating characteristic (ROC) analysis, univariate logistic regression and two-sample t-test were performed. RESULTS:The ROC analysis demonstrated good accuracy of the DEPS-R with an area under the curve (AUC) of 0.82 (95% CI 0.79-0.94). The cutoff of ≥20 yielded a sensitivity of 87.5% (95% CI 83.6%-91.3%) and a specificity of 60.4% (95% CI 54.8%-66.0%). Univariate logistic regression identified 12 items as significantly correlated with the presence of any eating disorder. The highest odds ratios (OR) were observed for items 9 (OR = 3.64), 8 (OR = 2.85), 13 (OR = 2.36), 14 (OR = 2.23), 15 (OR = 1.99) and 5 (OR = 1.99). CONCLUSIONS:This is the first study to investigate the ability of the DEPS-R to identify DSM-5 eating disorder diagnosis established via a diagnostic interview using a ROC-analysis. DEPS-R cutoff ≥20 correctly identified most cases with eating disorders but showed moderate specificity, considered acceptable as an initial screening tool for disordered eating. In clinical care, specific DEPS-R items may be emphasized to explore the presence of disordered eating behaviours and eating disorders.

OBJECTIVE:Mealtimes are associated with heightened distress among individuals with eating disorders (EDs) and are frequently accompanied by ritualized eating behaviors that maintain psychopathology. In inpatient settings, post-meal rest is commonly prescribed to prevent compensatory behaviors. Yet, enforced inactivity may exacerbate anxiety and ritual engagement. This study used ecological momentary assessment (EMA) to examine whether structured light post-meal activity is associated with a reduced likelihood of ritualized eating behaviors in an inpatient ED sample. METHOD:Participants were 33 inpatients who completed a 2-week counterbalanced within-subject crossover protocol, consisting of 1 week of standard post-meal rest and 1 week allowing structured light post-meal activity. EMA prompts were delivered six times daily. Ritualized eating behaviors were assessed following reported eating episodes and coded dichotomously. A binomial generalized linear mixed-effects model with random intercepts for participants tested whether the likelihood of ritualized eating behaviors differed between conditions. RESULTS:Participants completed 1503 EMA prompts (81.3% compliance). Across 1192 meal-related assessments, ritualized eating behaviors were reported in 30.8% of prompts during the rest condition and 24.2% during the post-meal activity condition, with substantial variability across individuals. Participants were significantly less likely to engage in ritualized eating behaviors during weeks allowing post-meal activity compared with rest-only weeks (B = -0.70, SE = 0.19, p = 0.0002), corresponding to an ~50% reduction in odds. DISCUSSION:The findings suggest that supervised post-meal movement may help interrupt ritual engagement during a high-risk period and demonstrate the utility of EMA for examining behavioral mechanisms in inpatient care.

Individuals with type 1 diabetes (T1D) are at increased risk of developing disordered eating (DE) and eating disorders (ED). Diabetes self-management focuses on food and insulin administration, which may contribute to development of EDs. The dual diagnosis may contribute to suboptimal glycemia, early diabetes-related complications and mortality. Evidence for ED prevention programs for this high-risk population remains limited. This systematic review aims to evaluate the feasibility and efficacy of available interventions to prevent EDs and improve glycemia in people with T1D. A literature search of PubMed, Embase, PsycINFO, CINAHL and Web of Science was conducted on 25 January 2025. Studies using randomized controlled, quasi-experimental or cohort design that targeted ED prevention in T1D population were included. Nine studies met the inclusion criteria, featuring interventions such as cognitive dissonance based programs, psychoeducation and self-compassion programs. Cognitive dissonance based programs demonstrated the most consistent reduction in ED risks and symptoms. However, most studies showed negligible improvement in glycemia. Common limitations were small sample sizes, high drop-out rates and short follow-ups. Future research should focus on well-powered RCTs to evaluate interventions over longer timeframes, younger age groups, both genders, carer involvement and additional modifications to improve glycemia concurrently. People with type 1 diabetes (T1D) must pay continual attention to food consumption and insulin administration daily to self-manage their blood sugar levels. This constant focus on food can increase the risk of developing disordered eating behaviors/thoughts and eating disorders. When individuals are diagnosed with both T1D and an eating disorder, blood sugar levels are unstable, resulting in a much higher risk of early diabetes complications, hospitalization and shortened lifespan. We reviewed studies that tested programs to prevent eating disorders in individuals with T1D. We found nine studies that included different types of programs, such as group discussions that challenge negative body image (cognitive dissonance based programs), psychology-based educational sessions, resilience and self-compassion workshops. Programs using cognitive dissonance approaches showed the most benefit in lowering eating disorder risk. However, none of the studies showed significant improvement in blood sugar levels. Overall, research in this area is still limited. Many studies were small and short-term. More long-term, larger studies are needed to understand what works best, especially for younger individuals and across genders. Involving families and adjusting the programs to also support blood sugar management could help future programs be more effective.

BACKGROUND:Co-occurrence of eating disorders (ED) and type 1 diabetes (T1D) can lead to deterioration in glycaemic control with reduced quality of life, microvascular complications, diabetic ketoacidosis and premature death. The current trial aims to test the effectiveness of an Australian Diabetes Body Project (ADBP) programme, a cognitive dissonance-based group intervention, on ED risk factors and symptoms, psychometric analysis, quality of life and glycaemia control in young women with T1D. METHODS:Mixed methods, prospective randomized controlled trial (RCT) using an online, six-week group intervention facilitated by a clinician and a peer with T1D. A sample of 80 young women with T1D aged 15 to 30 years will be randomized to the ADBP or active control (educational videos) condition. Participants will complete assessments of body dissatisfaction, eating behaviours, quality of life and diabetes distress, at baseline, post-intervention and at three-month follow-up. Medical record data will be extracted to determine changes in glycaemia outcomes. ADBP participants will be invited to provide feedback on the benefits and acceptability of the intervention. DISCUSSION:The ADBP will be the first clinic-based RCT to examine the effectiveness of a virtual, cognitive dissonance-based intervention for reducing ED risk factors and symptoms in young women with T1D. The results of this project will have immediate implications for clinical practice in Australia and globally, given the increasing prevalence of ED in this high-risk group and limited effective prevention programmes available. TRIAL REGISTRATION:The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (Trial ID: ACTRN12624000555550); accessible at (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12624000555550).

The objective of this study was to evaluate the Diabetes Eating Problems Survey-Revised (DEPS-R) against the Eating Disorder Diagnostic Interview (EDDI). Specific aims were to (1) assess the ability of the DEPS-R to identify Diagnostic and Statistical Manual-5 (DSM-5) eating disorders, including sensitivity and specificity of the current DEPS-R cutoff ≥20 and (2) report the correlation of each item to the presence of any eating disorder. Baseline data from 293 women (14–35 years) with type 1 diabetes (T1D) and body image concerns enrolled in a multinational randomized controlled trial were examined. Receiver operating characteristic (ROC) analysis, univariate logistic regression and two-sample t -test were performed. The ROC analysis demonstrated good accuracy of the DEPS-R with an area under the curve (AUC) of 0.82 (95% CI 0.79–0.94). The cutoff of ≥20 yielded a sensitivity of 87.5% (95% CI 83.6%–91.3%) and a specificity of 60.4% (95% CI 54.8%–66.0%). Univariate logistic regression identified 12 items as significantly correlated with the presence of any eating disorder. The highest odds ratios (OR) were observed for items 9 (OR = 3.64), 8 (OR = 2.85), 13 (OR = 2.36), 14 (OR = 2.23), 15 (OR = 1.99) and 5 (OR = 1.99). This is the first study to investigate the ability of the DEPS-R to identify DSM-5 eating disorder diagnosis established via a diagnostic interview using a ROC-analysis. DEPS-R cutoff ≥20 correctly identified most cases with eating disorders but showed moderate specificity, considered acceptable as an initial screening tool for disordered eating. In clinical care, specific DEPS-R items may be emphasized to explore the presence of disordered eating behaviours and eating disorders.

OBJECTIVE:Women with type 1 diabetes (T1D) tend to have fewer children and the postnatal period can be particularly challenging, as the rapid decline in pregnancy-induced insulin resistance often complicates diabetes management. The aim of this study was to explore postnatal experiences of women with T1D and their perspectives regarding future pregnancies. METHODS:This qualitative study is part of the "Reproductive health in diabetes and prediabetes-study". Individual interviews using a semi-structured interview guide were conducted with 17 women with T1D, with or without pregnancy experience, aged 18-45 years. For the present analysis, we included a sub-sample of eight women who had previously given birth. Data were analysed employing thematic analysis. RESULTS:Three themes were identified, each with two corresponding sub-themes. 1) The women faced challenges in early postnatal diabetes management, dealing with unpredictable blood glucose and hypoglycaemia. 2) They expressed a sudden shift in the level of diabetes support after birth and that the health care providers at the maternity ward lacked diabetes competence. 3) Although they did not want diabetes to affect family planning, they acknowledged that T1D complicated their lives and influenced their pregnancy timing. CONCLUSION:Women with T1D experienced considerable challenges in postnatal diabetes management, primarily due to unpredictable blood glucose levels and insufficient postnatal follow-up. These findings highlight the importance of more systematic and individualized postnatal support. Moreover, the impact of diabetes on family planning underscores the need for comprehensive information and tailored guidance in reproductive health decision making.

BACKGROUND:Optimal treatment and support in family planning for women with type 1 diabetes (T1D) and follow-up during pregnancy are important, however, there is limited knowledge from the women's perspective on their considerations of family planning, pregnancy, and motherhood. OBJECTIVES:To explore expectations and experiences of family planning, pregnancy, and motherhood among women with T1D. DESIGN:We employed a qualitative study design with semi-structured interviews. METHODS:We conducted semi-structured individual interviews (June to November 2022) with 17 women with T1D aged 18-45 at a diabetes outpatient clinic in Norway. We analyzed the data using thematic analysis. RESULTS:Four main themes, each with sub-themes, linked to a timeline from planning the pregnancy to becoming a mother were identified: (1) Existential considerations in family planning; (2) Ambiguous information sources and the need for individualized guidance about pregnancy and T1D; (3) Preparations for pregnancy and balancing uncertainties during pregnancy; and (4) Motherhood intertwined with diabetes. Overall, the women expressed a need for support in handling and managing their glucose control in the phase of family planning, during pregnancy, and when preparing for the role of mother. CONCLUSION:Women with T1D reported many worries and concerns related to family planning, pregnancy, and motherhood, and thus, individualized information and support related to diabetes and reproductive health should be an integrated part of follow-up care. Women with T1D seem to have high expectations and strong commitment to their diabetes self-management during pregnancy, conditional on support and guidance from health care providers (HCPs). A sensitive approach from HCPs in clinical consultations is vital to meet the individual woman's need for support. More research about reproductive health in women with T1D is needed, especially regarding how motherhood and diabetes intersect in everyday life.

Introduction and Objective: Disordered eating behaviors (DEB) are common in young women with type 1 diabetes (T1D) and are associated with suboptimal glycemic outcomes. The use of automated insulin delivery systems (AID) has shown to improve glycemia in individuals with T1D. However, the impact of DEBs on glycemic outcomes in AID users is unknown. Methods: Baseline data of young women (18-35 years old) including demographics, HbA1c, continuous glucose monitoring (CGM) metrics, total daily use of insulin (TDD), and Diabetes Eating Problem Scale-Revised (DEPS-R) questionnaire were collected. A DEPS-R score ≥20 indicates an increased risk of DEB. CGM data were analyzed for TIR (time in range 70-180 mg/dL), time above range (TAR >180 mg/dL), glucose management indicator (GMI%), and glycemic variability (CV%) Baseline measures were compared between participants with and without increased risk of DEB. Results: Data of 52 young women (age 25±4 years, BMI 27.6±6 Kg/m2, duration of diabetes 13±6 years; A1c 6.8±0.6%) on AID systems were evaluated. When divided by DEPS-R score (<20 or ≥20), participants with an increased risk of DEB (n=18) had a higher BMI (30.5±5 vs 26.3±5.4 kg/m2; p=0.04), greater HbA1c (7.2±0.8 vs 6.5±0.7%; p=0.004), and higher TDD (61±24 vs 45±22 v; p=0.002). Additionally, CGM metrics showed that the participants with DEPS-R score ≥20 had a lower TIR (57.7±14 vs 71±15%; p=0.03), higher TAR (28 vs 42%; p=0.003), and higher GMI (7.6 vs 7.05%; p= 0.01). The coefficient of variation (CV%) did not differ between participants with and without increased risk of DEB. Conclusion: In our cohort of young women with T1D using AID systems, less optimal glycemic outcomes are seen in those people at higher risk for DEB, suggesting that AID systems do not fully mitigate behavioral barriers to glycemic control. Routine screening for DEB and targeted psychosocial support should be considered in clinical practice. Disclosure E. Toschi: Consultant; Current; Vertex Pharmaceuticals Incorporated. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. H. Brabant: None. N. Patience: Advisory Panel; Current; Amylyx. M. Savory: None. L. Wisting: None. E. Stice: None. M. de Wit: Speaker's Bureau; Ended; Sanofi. Funding This study is funded by BreakthroughT1D (4-SRA-2022-1227-M-B)

In the article cited above, funding information was inadvertently omitted. The following text has been added: “This research was supported in part by National Institutes of Health grant P30 DK036836, which supports the Joslin Diabetes Center’s Clinical Research Center.” The authors apologize for the omission. The online version of the article (https://doi.org/10.2337/dc24-1599) has been updated with the correct funding information.

Introduction and Objective: Young women with type 1 diabetes (T1D) have a high prevalence of eating disorder (ED), resulting in suboptimal glycemia, early diabetes complications and mortality. Few ED prevention interventions have been evaluated in T1D and none have demonstrated significant metabolic benefit. To evaluate the effectiveness of the novel virtually-delivered peer-facilitated Australian Diabetes Body Project (ADBP), a cognitive-dissonance-based ED prevention program, in a clinic setting. Methods: Women with T1D aged 15-30 years were randomized to ADBP or active control of educational videos. ADBP comprised of 6-weekly, 1-hour, virtual, group sessions co-facilitated by a clinician and a T1D peer. Primary outcome was body dissatisfaction (BDS), secondary outcomes were thin-ideal internalization (IBSS-R), ED symptoms (EDEQ), diabetes-specific disordered eating behaviors (DEPS-R), HbA1c and CGM metrics at baseline (T1), post-intervention (T2), 3-month follow-up (T3). Glycemic outcomes were extracted from medical records. Analyses used REML mixed-effects models (ITT). Results: Eighty-five participants were randomized (Control n=43; ADBP n=42). Whilst no significant between-group differences were observed, both groups showed significant within-group improvements in BDS, IBSS-R and EDEQ from T1 to T2 and T3 (all p<0.001). DEPS-R reductions were larger in ADBP (-7.40 at T2/T3, p<0.001) than Control (-3.47 to -5.02, p=0.029-0.002). A significant between-group difference in HbA1c at T3 favored ADBP (adjusted mean difference -1.05%, 95% CI -1.62 to -0.48, p<0.001). Time-in-range and time-above-range improved more in ADBP, though nonsignificantly. Conclusion: A clinic-delivered ED prevention program for young women with T1D improved ED risks/symptoms and produced a clinically meaningful and significant HbA1c reduction, suggesting ADBP also improves metabolic outcomes. These ground-breaking findings have great implications for all Diabetes Services. Disclosure N. D'Silva: None. N.S. Sandoval: None. S.N. Gannon: None. E. Stice: None. L. Wisting: None. S.E. Bartlett: None. J.V. Jones: None. L.K. Phillips: None. C. Hendrieckx: None. Funding Mater Foundation - Betty McGrath Grant (3300)

AIMS:To examine and describe feedback after participation in a novel eating disorder prevention program for young women with type 1 diabetes (Diabetes Body Project) in a multinational randomised controlled trial. METHODS:Written feedback from participants (N = 109) and facilitators (N = 19) at four sites (Europe and US) was analysed using descriptive, manifest content analysis. Open-ended questions included motivation for participation, most/less valuable aspects of the program and suggestions for improvement. RESULTS:"Community" was the most important motivator and most valued aspect, reported by one-third of participants. When asked about less valued aspects of the program, participants and facilitators most frequently reported "none/not sure/everything was valuable" and "nothing" respectively. Suggestions to improve the program common for participants and facilitators were "more creative exercises", specific for participants after "none" was "limit homework/obligations" and specific for facilitators was "more flexibility to move away from the script". The three most frequently perceived barriers for participation reported by participants and facilitators were "requiring personal vulnerability", "time and energy constraints" and the "group setting". CONCLUSIONS:Participants and facilitators expressed overall high satisfaction with the program, specifically the value of T1D community. Additionally, they suggested incorporating more creative exercises. Future research should aim at widespread implementation and addressing barriers to participation.

Introduction and Objective: Young women with type 1 diabetes (T1D) are at high-risk for developing eating pathology, including eating disorders (ED) and diabetes-specific disordered eating behaviors (DS-DEB). Studies show a relation between eating pathology and poor glycemia, however, whether this relationship differs for ED and DS-DEB is not well known. We analyzed data from the Diabetes Body Project (DBP) trial to describe the relationship between eating patterns and glycemia in young women with T1D. Methods: Baseline clinical characteristics, including A1c and Time-in-Range (TIR), among young women (14-35 years old) with T1D and body image concerns from the DBP trial were analyzed. Participants underwent eating disorder diagnostic interview to assess ED and completed the Diabetes Eating Problem Scale-Revised (DEPS-R) questionnaire to assess DS-DEB. Elevated DS-DEB were defined as a DEPS-R score ≥20. Statistical analyses were performed. Results: Data from 293 women (age 25±5 years, 79% pump, 98% CGM, BMI 26±5.4 Kg/m2, A1c 7.0±1%, TIR 65.9±16.9%) were assessed. An ED diagnosis was present in 11%, and elevated DS-DEB in 45% of the cohort. More ED symptoms correlated with higher age (r=0.14, p=.02), BMI (r=0.26, p<.001) and A1c (r=0.15, p=.02). DS-DEB correlated with higher BMI (r=0.28, p<.001), A1c (r=0.28, p<.001), and lower TIR (r=-0.26, p<.001).When divided by TIR (<50%; 50%-70%; >70%) or by A1c (<6.5%; 6.5%-8%; >8%), DS-DEB was associated with lower TIR (<50% (mean=23.8) / 50-70% (mean=20.0) / >70% (mean=16.2)) (p<.001) and higher A1c (<6.5% (mean=16.3) / 6.5-8% (mean=18.5) / >8% (mean=25.4)) (p=.001). ED symptoms did not associate with either TIR or A1c in these analyses. Conclusion: In this large cohort of young women with T1D with relatively optimal glycemic outcomes, ED was present in one in every 10 participants and DS-DEB in almost half of the participants. DS-DEB showed stronger relations with glycemic outcomes than ED symptoms. Clinicians should consider screening for DS-DEB in young women with T1D independent of glycemic outcomes. M. de Wit: Speaker's Bureau; Medtronic. Consultant; Sanofi. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sequel Med Tech. Research Support; Dexcom, Inc. N. Patience: None. H. Brabant: None. S. Haugvik: None. M. Hennekes: None. L. Wisting: None. E. Stice: None. Supported by a grant from Breakthrough T1D.

Objective: Young women with type 1 diabetes are at risk to develop eating disorders (ED). We evaluated a novel ED prevention program in a multi-national randomized controlled trial. Research Design and Methods: Women (14-35 years) with type 1 diabetes were randomized to virtual Diabetes Body Project groups or educational control. Outcomes were assessed at pretest and posttest (1-2 weeks after intervention). Results: Compared to educational controls (n=146), participants in the Diabetes Body Project (n=147) showed significant improvements (all p<0.05) with small Cohen’s d effect sizes for ED symptoms (d=-0.30, CI -0.06,-0.69) (primary outcome), diabetes distress (d=-0.42), quality of life (d=0.39) and dietary restraint (d=-0.31), and medium effect sizes for diabetes-specific disordered eating behaviors (d=-0.70), body dissatisfaction (d=-0.59), and pursuit of thin appearance ideal (d=-0.56). Conclusions: The Diabetes Body Project produced significantly larger acute effects with small to medium effect sizes compared to educational controls and has potential for broad implementation.

AimsPeople with type 1 diabetes (T1D) face an increased risk of disordered eating (DE) and eating disorders (ED), associated with glucose levels outside target range and an increased risk of complications. The aim of this study was to investigate the type and severity of DE and assess the item accuracy of the Diabetes Eating Problem Survey Revised (DEPS-R) compared to the Youth Eating Disorder Examination Questionnaire (YEDE-Q) in the screening of DE among adolescents with T1D. MethodsCross-sectional online survey including DEPS-R, YEDE-Q and medical records. Item to total analysis with correlations, and group comparisons were performed. ResultsA total of 131 adolescents between 11 and 19 (mean age 15.3 +/- 2.2) years completed both DEPS-R and YEDE-Q, identifying 21.4% and 22.9% with DE, respectively. Significantly more females (>30%) than males (approximate to 5%) were identified in both measures. More than 50% reported insulin restriction in DEPS-R vs. 1.5% in YEDE-Q. YEDE-Q yielded 32% with weight controlling behaviours, however, half of these were unidentified by DEPS-R. Item-total analysis of DEPS-R showed that item 10 had small correlations to both total score and clinical variables. ConclusionThis study confirms the clinical relevance of DEPS-R, including associations between DE and female sex, older age, and glucose levels outside target range, however, it may not accurately capture distinct ED risk behaviours, such as excessive exercise or shape and weight related insulin restriction. The item-total analysis shows that the relevance of item 10 should be further investigated.

Background Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth. Methods In this study, 1558 girls (53%) and boys (47%), predominantly within the 16–19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure. Results Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. Conclusion A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people’s view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents’ satisfaction and appreciation of their body and appearance. Trial registration: The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P ).

People with type 1 diabetes (T1D) have an elevated risk of suicidal ideation and death by suicide compared with the general population. The aim of the present article is to provide updated and evidence-based knowledge about the association between T1D and suicide. A further aim is to discuss how specific psychological aspects of T1D may contribute to a heightened risk of suicide. We emphasize the importance of closeness to death, responsibility, stigmatisation, loneliness, shame, burnout, unpredictability and lack of control. Daily self-management is highly demanding. The illness is associated with a risk of severe somatic complications such as visual impairment, dementia, cardiovascular disease, impaired renal function and premature death. Type 1 diabetes also increases the risk of neuropathy, other types of painful conditions and fatigue. Finally, we suggest approaches that may help psychologists address these issues. Key words: type 1 Diabetes Mellitus, suicide, mental health issues, health psychology

Introduction: In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. Methods: Young women with T1D aged 16-35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. Results: Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen's ds ranged from .34 to 1.70). Conclusion: The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.

AIM:Young women with type 1 diabetes are a high-risk population for eating disorders (ED). Prevention programs are lacking. In young women without diabetes, the Body Project has produced reductions in ED risk factors, ED symptoms and future ED onset. Therefore, the Body Project was adapted to type 1 diabetes, the Diabetes Body Project (DBP). In this protocol, we describe the multi-site randomized controlled trial (RCT) to evaluate efficacy of the DBP. METHODS:This is an ongoing RCT with four sites (Europe and US). In total 280, 14-35 year-old, women with type 1 diabetes ≥1 year and some level of body image concerns will be recruited in 2023. Participants are randomized to either virtual DBP groups or an educational control. The study constitutes 5 measurement points distributed over 2 years. The primary aim is to test if DBP will produce significantly greater reductions in ED behaviours, ED symptoms and future ED onset. The secondary aim is to test if DBP has significantly greater improvements in diabetes distress, quality of life and glycaemic outcomes. RESULTS:We expect that DBP will be more efficacious in reducing ED behaviours, ED symptoms and ED onset compared to the control condition. Additionally, we hope to gain new knowledge on how DBP may affect diabetes-related outcomes. CONCLUSIONS:If DBP proves efficacious, it has potential for immediate, clinical implementation at low-cost and may contribute to broad prevention of future ED onset among young women with type 1 diabetes. CLINICALTRIALS: GOV IDENTIFIER:NCT05399446.