Effects of mindfulness‐ and acceptance‐based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta‐analysis

Abstract

Aim For people with type 2 diabetes, self management and fear of disease complication often cause psychological distress. Mindfulness and acceptance might be beneficial for reducing diabetes‐related distress and glycaemic level. We systematically review the effects of mindfulness‐ and acceptance‐based interventions on diabetes distress and glycaemic level in community‐dwelling adults with type 2 diabetes. Methods Seven electronic databases (English and Chinese) were searched comprehensively from inception to June 2020. Data extraction and methodological quality assessment were independently performed by two reviewers using Grading of Recommendations, Assessment, Development and Evaluations criteria. Results Nine RCTs (801 participants) examining the effects of acceptance and commitment therapy, mindfulness‐based cognitive therapy, mindfulness‐based stress reduction and self‐directed mindfulness practice were included. In the reviewed RCTs, the majority of participants (mean age: 50–66 years, average disease duration: 4–10 years) had suboptimal diabetes control (HbA1c >7.0%, 53 mmol/mol). Compared with controls, the interventions significantly reduced diabetes distress (standardised mean difference, SMD = −0.37, 95% confidence intervals, CI: −0.63, −0.12; p < 0.01) and HbA1c (mean difference, MD = −0.35, 95% CI: −0.67, −0.04; p = 0.03) up to 1‐month post‐intervention. However, the underpowered studies may have led to overestimation, the interventions for diabetes distress and HbA1c were heterogeneous. Conclusions Within evidenced‐based diabetes education programmes, mindfulness‐ and acceptance‐based approaches may reduce distress and HbA1c levels and promote self care in people with type 2 diabetes. Further controlled trials are recommended to examine the clinical effectiveness of such programmes for people with type 2 diabetes of diverse clinical, cultural and socio‐demographic backgrounds.

Implications of COVID-19 on the Loneliness of Older Adults in Residential Care Homes

“…However, therein lies the problem: the prescriptive culture necessary to prioritizing infection control during COVID-19 saves lives (Lum et al, 2020), but is not conducive to transmitting the emotions needed to resolve anxieties (Reay, 2017). Grounded in the collapse of self-interpretation, healthcare interventions (e.g., acceptance and commitment therapy) might creatively promote mindful changes to offset further experiences of loneliness particularly during a pandemic (Hayes et al, 2006;Ngan et al, 2021).…”

ACTonDiabetes: study protocol of a pragmatic randomised controlled trial for the evaluation of an acceptance and commitment-based internet-based and mobile-based intervention for adults living with type 1 or type 2 diabetes

“…A meta-analysis on ACT interventions for the reduction of diabetes distress revealed a reduction of Standardized Mean Difference (SMD) =0.37 in favour of IGs in comparison to TAU or TAU +controls. 38 As a consequence the pooled effect size of d=0.45 is being expected. Power analysis with G*Power 91 recommend a sample size of 105 participants per group on the assumption of two-tailed testing, an alpha error probability of α=0.05 and power of 1−β=0.90.…”

“…Recent meta-analyses on ACT-based interventions report promising results. One meta-analysis reveals reductions of diabetes distress (SMD=−0.37, 95% CI −0.63 to −0.12),38 two meta-analyses report reductions in glycated haemoglobin (HbA 1C ) (MD=−0.35 and −0.62% points)38 39 in favour of intervention groups (IGs) when compared with treatment as usual (TAU) or enhanced TAU+. However, both meta-analyses call for further high-quality studies in the field 38 39…”

The Chinese version of the revised Diabetes Distress Scale for adults with type 2 diabetes: Translation and validation study

“…Type 2 diabetes (T2D) is a growing burden, with an estimated 416.70 million adult patients worldwide and 110.58 million patients in China [ 1 ]. It is a chronic metabolic disease characterized by hyperglycemia, which is caused by the inability of pancreatic β cells to secrete enough insulin or the inability of the body to effectively use the secreted insulin [ 2 ]. T2D influences both physical and mental health.…”

“…DD is associated with low compliance, glycemia, adverse outcomes, and increased costs [ 3 ]. Moreover, although DD is not a psychiatric symptom, it could progress to depression if not properly managed [ 2 ]. Therefore, the American Diabetes Association recommends physicians and nurses evaluate DD in disease development and treatment [ 9 ].…”