Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis

Abstract

To review the evidence and determine the factors influencing the effect of mindfulness-based interventions (MBI) on diabetes distress. A systematic search of nine databases (PubMed, Cochrane Library, Web of Science, PsycINFO, Embase, China Knowledge Resource Integrated, VIP Data, SinoMed Data, and Wan Fang Data) was conducted. Randomized controlled trials of MBIs for adults with diabetes that evaluated the effect of the interventions on diabetes distress were retrieved. Meta-analysis was conducted by using Review Manager V.5.3, a Cochrane Collaboration tool. Subgroup analyses were conducted for exploring factors influencing the effect of MBIs on diabetes distress. A total of 10 articles, consisting of eight studies with 649 participants, were included. The results from subgroup analyses on the studies revealed five factors that influenced the effect of MBIs on diabetes distress compared with control group. Participants with elevated baseline diabetes distress showed a moderate effect size of 0.48 of decreasing diabetes distress when receiving MBIs (p=0.005); the MBIs based on mindfulness-based stress reduction therapy alleviated diabetes distress of the participants with a large effect size of 0.58 (p<0.0001); the MBIs delivered in group format decreased the diabetes distress with a moderate effect size of 0.36 (p=0.03); the MBIs with home practice assignment alleviated the diabetes distress with a moderate effect size of 0.42 (p=0.05). The long-term rather than short-term effect of MBIs on diabetes distress reduction has been identified with large effect size of 0.56 (p=0.04). MBIs improve outcomes in adults with diabetes who have elevated diabetes distress at baseline, using mindfulness-based stress reduction therapy, using a group format to deliver the intervention, and assigning home practice. MBIs improve diabetes distress significantly more at long-term follow-up compared with short-term follow-up. MBIs could be considered as an adjunct treatment in adults with diabetes to reduce diabetes distress.

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

“…Three studies 35,37,40 had high risk of bias because a substantial proportion of the outcome data (>20%) was missing. Five studies were classified as having ‘some concerns’ related to the risk of ‘bias in the selection of the reported results’, 23,34,35,38,39 which were due to the incomplete reporting of the means and SDs of the outcome measures in either or both study groups, 34,37,38,40 or to the selective reporting of significant results 36 . Overall, only three studies 18,36,39 were rated as having ‘some concerns’ regarding the risk of bias, and the remaining six studies were judged as having a ‘high risk of bias’.…”

“…Notably, most of the interventions in the included studies encouraged daily home practice of mindfulness skills to enhance the sustainability of the therapeutic effects. Mindfulness‐based interventions involving home practice were found to effectively alleviate diabetes distress, when compared with those without home practice 23 . In a narrative review of 14 controlled studies, the majority of the mindfulness‐based interventions encouraged the home practice of mindfulness by integrating an audio CD or video with self‐reported logbooks, 51 and reported significantly greater reduction in insomnia or psychological disorders, when compared with usual care.…”

“…Another recent review of mindfulness‐based interventions 23 evaluated diabetes distress but not HbA 1c as the outcome measure, and the pooled analysis of diabetes distress revealed substantial heterogeneity (I 2 =53%), small per‐study sample size (range: 24–139) and poor methodological quality. The aforementioned systematic reviews 22,23 do not broaden our understanding of the evidence from methodologically rigorous clinical trials of the effects of various types of mindfulness‐ and acceptance‐based interventions (e.g. acceptance and commitment therapy) on diabetes distress and glycaemic level in people with type 2 diabetes.…”

“…Although a recent systematic review explored studies of mindfulness‐based interventions that assessed both diabetes distress and HbA 1c levels, it only included studies published up to 2015 and therefore provides an incomplete review of the updated evidence 22 . Another recent review of mindfulness‐based interventions 23 evaluated diabetes distress but not HbA 1c as the outcome measure, and the pooled analysis of diabetes distress revealed substantial heterogeneity (I 2 =53%), small per‐study sample size (range: 24–139) and poor methodological quality. The aforementioned systematic reviews 22,23 do not broaden our understanding of the evidence from methodologically rigorous clinical trials of the effects of various types of mindfulness‐ and acceptance‐based interventions (e.g.…”

Immediate and Long-Term Effects of an 8-Week Digital Mental Health Intervention on Adults With Poorly Managed Type 2 Diabetes: Protocol for a Randomized Controlled Trial

“…Such interventions appear to be particularly successful when patients have higher baseline levels of diabetes-related distress and when interventions are delivered in a group format, draw on mindfulness-based stress reduction (MBSR), and include home practice assignments [ 32 ]. Although few of these studies have included long-term follow-up, there is preliminary evidence that the effects of mindfulness-based interventions on depressive symptoms are maintained, or even stronger, after 6 months [ 30 , 32 ], although they may dissipate after 2 or 3 years postintervention [ 30 ]. Some findings also suggest that the effects of mindfulness-based interventions on HbA 1c levels may actually be stronger 1 or 3 months postintervention rather than immediately postintervention [ 30 ].…”