Evaluation of integrated diabetes and mental health services to support patients with Type 1 diabetes related disordered eating (T1DE)

Background

The management of Type 1 diabetes can make individuals more vulnerable to disordered eating behaviours. Insulin restriction or omission as a purging behaviour to control body weight is of particular concern as it is associated with increased morbidity and as much as a threefold increase in mortality.

This is a clinical issue that cuts across both the mental health and diabetes disciplines, but one which requires a different approach to the traditional treatment methodologies of both conditions.

In response to growing recognition of unmet need, NHS England commissioned a pilot of two exploratory Type 1 diabetes disordered eating services, with the aim of developing the evidence base around how best to manage this high-risk cohort by testing an integrated diabetes and mental health pathway.

However, as the pilot implementation and evaluation were conducted during the COVID-19 pandemic, this combined with the relatively small amount of participant data available means that limited conclusions could be drawn.

What we are doing

Our overall aim is to provide a clinically robust, high-quality evaluation is required to determine how the NHS can best support patients with Type 1 diabetes related disordered eating.

We will conduct a multi-site, multiple-methodologies study, conducting interviews with staff, wider stakeholders and service users who are either delivering or in receipt of the T1DE service.

We will:

1. Describe service delivery models and how they were developed and are evolving.
2. Investigate whether service implementation is being achieved (compared against service specifications) and in a way that is acceptable to staff. We will explore contextual factors that contribute to implementation progress.
3. Investigate how service delivery is being sustained, exploring any adaptations made to services over time with the aim of supporting ongoing activity and enhancing service delivery.
4. Investigate the experiences of service users.
5. Explore the costs of the service against the clinical consequences for service users.