Adult users of a digital binge-eating intervention wanted adaptations for type 2 diabetes: Qualitative study of post-intervention preferences

Purpose: Binge eating, defined as eating a large amount of food while feeling a loss of control, impacts up to 25% of adults with type 2 diabetes mellitus (T2DM). Although binge eating worsens physical health and mental health in adults with diabetes, binge-eating interventions have rarely been adapted for diabetes. To address this gap, we asked adults with T2DM and binge eating who completed a digital binge-eating intervention (FoodSteps) about challenges they experience and opportunities to adapt FoodSteps for diabetes. Methods: Participants were drawn from two trials testing FoodSteps. Eligible participants were adults (≥18 years) with T2DM and recurrent binge eating (≥12 episodes in the past 3 months). Post-intervention interview data were analyzed using methods from thematic analysis. Results: Forty-two participants were included: 74% self-identified as female; 14% as Hispanic, 14% as non-Hispanic and another race, 33% as non-Hispanic Black, and 38% as non-Hispanic White. Participants described challenges managing T2DM due to knowledge barriers, cognitive/psychological barriers, physiological barriers, and external/structural barriers. Participants suggested adaptations to address these barriers, including psychoeducation, reminders, glucose tracking features, and increased medical support and social support. Participants said that individuals recently diagnosed with T2DM may benefit most from adapted intervention. Conclusions: Results indicate opportunities to adapt the design and delivery of binge-eating intervention for diabetes, though these design ideas must be validated with new users. This research has implications for diabetes care clinicians, who may benefit from addressing patients’ eating behaviors. Future work will design adapted intervention features with clinicians and adults with diabetes.