Addressing binge eating in people with type 2 diabetes: Co-creating and feasibility testing dialogue tools based on a design thinking approach.

Background: Binge eating disorder may affect one in four individuals with type 2 diabetes, potentially leading to negative health outcomes. However, binge eating often goes unaddressed in diabetes care due to the absence of screening tools and the reluctance of patients to seek help due to shame and guilt. Objective: The study aim was to develop acceptable and feasible diabetes-specific dialogue tools to facilitate discussions about binge eating between patients with type 2 diabetes and clinicians, serving as a first step toward the detection and management of potential binge eating in this population. Design: The development and evaluation of the dialogue tools were conducted according to the Medical Research Council's complex interventions framework. Setting: Individuals with type 2 diabetes and clinicians were recruited from a specialized regional diabetes hospital during March to September 2023. Researchers were recruited from the same hospital and relevant research networks. Participants: The co-creation process consisted of 11 workshops and 16 individual feedback meetings with people with type 2 diabetes ( Methods: Applying a design thinking approach, the dialogue tools were co-created with individuals with type 2 diabetes, diabetes clinicians, and researchers with diabetes and/or eating disorder expertise. The dialogue tools were feasibility tested consecutively in routine diabetes consultations. Results: The study generated three dialogue tools aiming to facilitate discussions among clinicians and patients with type 2 diabetes about the patients' i) daily thoughts about food and drink, and whether they find these burdensome, ii) eating and drinking patterns, and iii) overall eating habits. Each dialogue tool included three parts; in part one, potential eating challenges in everyday life with diabetes are described, and the purpose of the exercise embedded in the tool is described. In part two, the patient actively carries out the described exercise, and in part three, the patient and clinician discuss follow-up questions. Parts two and three were designed to help patients recognize and reflect on their eating behaviors. Potential binge eating behaviors were identified in 25 % of the consultations, while other eating challenges that could impact diabetes management were commonly discussed in the remaining consultations. Conclusions: The dialogue tools may be effective in addressing not only binge eating but also other significant eating challenges in individuals with type 2 diabetes during routine diabetes consultations. Further research is encouraged to evaluate the tools in different settings.