Effects of an integrated mindfulness intervention for veterans with diabetes distress: a randomized controlled trial

Abstract

IntroductionUS military veterans have disproportionately high rates of diabetes and diabetes-related morbidity in addition to being at risk of comorbid stress-related conditions. This study aimed to examine the effects of a technology-supported mindfulness intervention integrated into usual diabetes care and education on psychological and biobehavioral outcomes.Research design and methodsVeterans (N=132) with type 1 or 2 diabetes participated in this two-arm randomized controlled efficacy trial. The intervention arm received a one-session mindfulness intervention integrated into a pre-existing program of diabetes self-management education and support (DSMES) plus one booster session and 24 weeks of home practice supported by a mobile application. The control arm received one 3-hour comprehensive DSMES group session. The primary outcome was change in diabetes distress (DD). The secondary outcomes were diabetes self-care behaviors, diabetes self-efficacy, post-traumatic stress disorder (PTSD), depression, mindfulness, hemoglobin A1C (HbA1C), body weight, and blood pressure. Assessments were conducted at baseline, 12 weeks, and 24 weeks. Participant satisfaction and engagement in home practice were assessed in the intervention group at 12 and 24 weeks.ResultsIntention-to-treat group by time analyses showed a statistically significant improvement in DD in both arms without significant intervention effect from baseline to 24 weeks. Examination of distal effects on DD between weeks 12 and 24 showed significantly greater improvement in the intervention arm. Improvement in DD was greater when baseline HbA1C was <8.5%. A significant intervention effect was also shown for general dietary behaviors. The secondary outcomes diabetes self-efficacy, PTSD, depression, and HbA1C significantly improved in both arms without significant intervention effects. Mindfulness and body weight were unchanged in either group.ConclusionsA technology-supported mindfulness intervention integrated with DSMES showed stronger distal effects on DD compared with DSMES control. Examination of longer-term outcomes, underlying mechanisms, and the feasibility of virtual delivery is warranted.Trial registration numberNCT02928952.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023

“…A multisite RCT with adults with type 1 diabetes and elevated diabetes distress and A1C demonstrated large improvements in diabetes distress and small reductions in A1C through two 3-month intervention approaches: a diabetes education intervention with goal setting and a psychological intervention that included emotion regulation skills, motivational interviewing, and goal setting (369). Among adults with type 2 diabetes in the Veterans Affairs system, an RCT demonstrated benefits of integrating a single session of mindfulness intervention into DSMES, followed by a booster session and mobile app-based home practice over 24 weeks, with the strongest effects on diabetes distress (370). An RCT of cognitive behavioral therapy demonstrated positive benefits for diabetes distress, A1C, and depressive symptoms for up to 1 year among adults with type 2 diabetes and elevated symptoms of distress or depression (371) (374).…”

The Effect of Mindfulness Based Stress Reduction on Glycemic Control and Psychological Well-being of Diabetes Mellitus Patients: A Review of Experimental Studies

“…Some of the midnfulness research was conducted in the Asian countries including Iran (Kian et al, 2018) (Hosseini et al, 2021)(Ravari et al, 2020), Saudi Arabia (Obaya et al, 2023) and China (Guo et al, 2022). Other countries that have conducted studies on mindfulness are Australia (Pearson et al, 2018), Canada (Dreger et al, 2015)and the United States (DiNardo et al, 2022) (Xia et al, 2022) (Whitebird et al, 2018). In conducting mindfulness research, most researchers use two groups, namely a treatment group (mindfulness or a combination with other therapies) and a control group in the form of education, regular care or physical activity (Kian et al, 2018) (Hosseini et al, 2021) (Pearson et al, 2018) (Ravari et al, 2020) (DiNardo et al, 2022) (Obaya et al, 2023) (Guo et al, 2022).…”

“…Other countries that have conducted studies on mindfulness are Australia (Pearson et al, 2018), Canada (Dreger et al, 2015)and the United States (DiNardo et al, 2022) (Xia et al, 2022) (Whitebird et al, 2018). In conducting mindfulness research, most researchers use two groups, namely a treatment group (mindfulness or a combination with other therapies) and a control group in the form of education, regular care or physical activity (Kian et al, 2018) (Hosseini et al, 2021) (Pearson et al, 2018) (Ravari et al, 2020) (DiNardo et al, 2022) (Obaya et al, 2023) (Guo et al, 2022). The research was conducted on type 2 DM patients with an average age of 45.24 – 63.7.…”

“…The type of mindfulness intervention used in most research is MBSR (Mindfulness Based Stress Reduction) (Kian et al, 2018) (Ravari et al, 2020) (Dreger et al, 2015) (DiNardo et al, 2022) (Whitebird et al, 2018) (Xia et al, 2022) (Guo et al, 2022). MBSR is carried out for 4 weeks (low dose) (Xia et al, 2022), 8 weeks (Dreger et al, 2015) (Kian et al, 2018) (Pearson et al, 2018) (Dreger et al, 2015) (DiNardo et al, 2022) (Whitebird et al, 2018) and 12 weeks (Ravari et al, 2020). Mindfulness is provided by trained professionals and taught again using communication media, namely CDs (Pearson et al, 2018) (Whitebird et al, 2018) or mobile application (DiNardo et al, 2022).…”

“…The Effect of Mindfulness on Psychological Well-being Mindfulness has an effect on controlling the patient's psychological problems, especially those related to inadequate self-management. MBSR programs increase the wellbeing in type 2 DM patients (Kian et al, 2018)namely by reducing depression (DiNardo et al, 2022) (Xia et al, 2022), depression and anxiety (HARS, and HDRS scores with p < 0.05), reducing depression and stress (Pearson et al, 2018), improvement of resilience and psychological well-being (Hosseini et al, 2021), (Guo et al, 2022) emotional health (Dreger et al, 2015). Apart from being assessed using instruments to evaluate psychological conditions, psychological effects are also assessed from the results of laboratory values, namely cortisol.…”