Integrated Therapy to Improve Care for Disordered Eating in T1D
Natalie Zaremba, Amy Harrison, Jennie Brown, Divina Pillay, Emmanouela Konstantara, Janet Treasure, David Hopkins, Judith Prins, Bastiaan de Galan, Khalida Ismail, Giesje Nefs and Marietta Stadler.
Experiences of receiving and delivering a novel complex intervention for type 1 diabetes and disordered eating: Process evaluation of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY). iabet Med. 2026 Nov;43(11):e70377. Epub 2026 Jun 11.
Disordered eating in people with type 1 diabetes (T1D) presents unique challenges. Eating behaviours, insulin management, glucose levels and emotional well-being are closely connected, while conventional eating disorder treatments may not adequately address the demands of diabetes self-management.
The STEADY programme was developed to address these challenges by combining cognitive behavioural therapy (CBT) with diabetes-specific education and support. This publication, co-authored by Diabeter NL/Diabeter Center Amsterdam author Giesje Nefs, explores how people receiving STEADY and healthcare professionals delivering it experienced the intervention, and whether it could be suitable for wider use. Researchers conducted interviews and collected questionnaires from 13 adults with T1D and disordered eating who received STEADY therapy, alongside three healthcare professionals involved in delivering the intervention. STEADY consisted of 12 personalised therapy sessions.
Key findings:
- High acceptability and feasibility: Both participants and healthcare professionals rated STEADY positively for acceptability, appropriateness and feasibility.
- Integrated care was particularly valuable: Combining expertise in diabetes and eating disorders helped participants address problems that conventional treatments had not adequately covered.
- Personalised therapy supported meaningful change: Participants described gaining insight into their behaviours, developing coping skills and becoming more confident in managing diabetes-related challenges.
- Trust and specialist knowledge were essential: A supportive therapeutic relationship and an understanding of the interaction between diabetes and disordered eating helped participants feel understood and engage with therapy.
- Flexibility and longer-term support may be needed: Participants and therapists valued adaptable session content and scheduling. Some felt that 12 sessions were insufficient to address more complex or longstanding difficulties.
The findings suggest that integrated, personalised psychological care is a promising approach for people with T1D and disordered eating. However, delivering STEADY more widely would require specialist training, multidisciplinary collaboration and flexibility in how therapy is provided. As this was a small process evaluation within a feasibility trial, further research is needed to establish the effectiveness of STEADY in a larger randomised controlled trial.
Concluding, the authors state
“Our findings demonstrate that STEADY is acceptable, appropriate and feasible for individuals with mild to moderate severity T1DE.”
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