Evaluating the implementation of the Diabetes Body Project in a clinical cohort of Australian adolescents with type 1 diabetes.

Introduction: Adolescents with type 1 diabetes (T1D) are at increased risk of disordered eating behaviors (DEB) and eating disorders (ED) compared to their peers without T1D, contributing to increased diabetes-related complications, and elevated mortality risk. Despite this, there is a lack of targeted ED prevention interventions specifically designed for adolescents with T1D, within routine clinical care. The Diabetes Body Project (DBP) has demonstrated promising feasibility, acceptability, and reduction of DEB in young adults; however, its application in younger adolescents and real-world clinical settings has not been tested. Objective: This study aims to extend previous DBP research by evaluating its implementation within a real-world Australian clinical service. The study will assess feasibility and acceptability and explore preliminary efficacy in relation to DEB and glycaemic control in an exclusively adolescent population, including a novel parent/caregiver component. Methods: This protocol describes a pilot study that will recruit 24 female adolescents with T1D from the John Hunter Children's Hospital (JHCH) Diabetes Service in New South Wales, Australia, along with up to 24 parents/caregivers. Adolescents will participate in a 6-week virtually delivered manualised cognitive dissonance based DBP program, delivered in a group format across four cohorts of 6 adolescents. In addition, two group sessions will be developed and delivered virtually to parents/caregivers for each cohort. Outcomes will be assessed at baseline, post-intervention and at 3 and 6 months follow up. Feasibility will be evaluated through recruitment, retention, attendance, between-session activity completion and parent/caregiver uptake. Acceptability will be assessed via participant and caregiver satisfaction surveys. Preliminary efficacy will be explored through changes in disordered eating behaviors (Diabetes Eating Problem Survey-Revised), body appreciation (BAS-2), diabetes distress (PAID-T), and glycaemic outcomes. Discussion: This study will evaluate the implementation of an adapted DBP intervention for adolescents with T1D within a real-world clinical service. By incorporating a novel parent/caregiver component and targeting the adolescent population, the study addresses key gaps in current literature. Findings may inform the design of future larger-scale trials and support the integration of ED prevention strategies into routine pediatric diabetes care.