Reduce Distress with Diabetes with Mindfulness
By John M. de Castro, Ph.D.
“I fight a battle against my body every day. One that doesn’t end, with no breaks, and no finish line. I keep fighting even when I’m tired, weak, or when I feel I’ve had enough. I fight for my health in more ways than others understand. Until there is a cure.” – The Diabetic Journal
Diabetes is a major health issue. It is estimated that 30 million people in the United States and nearly 600 million people worldwide have diabetes, and the numbers are growing. Diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.
Dealing with diabetes causes considerable distress in the patient. Mindfulness practices have been shown to be helpful in managing diabetes. This predicts that mindfulness training should reduce diabetes distress.
In today’s Research News article “Effects of an integrated mindfulness intervention for veterans with diabetes distress: a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961140/ ) DiNardo and colleagues studied the effectiveness of online mindfulness raining in reducing diabetes distress in military veterans who were receiving education and support with diabetes self-management.
They found that the education and support program produced significant improvements in both the psychological and physical symptoms of diabetes. But the additional mindfulness training produced a greater reduction in diabetes distress and improvements in dietary behaviors. This suggests that mindfulness training should be incorporated into diabetes management programs.
“Diabetes is like a roller coaster. It has its ups and downs, but it’s your choice to scream or enjoy the ride.” – Melissa Skrocki
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts are also available on Twitter @MindfulResearch
DiNardo MM, Greco C, Phares AD, Beyer NM, Youk AO, Obrosky DS, Morone NE, Owen JE, Saba SK, Suss SJ, Siminerio L. Effects of an integrated mindfulness intervention for veterans with diabetes distress: a randomized controlled trial. BMJ Open Diabetes Res Care. 2022 Mar;10(2):e002631. doi: 10.1136/bmjdrc-2021-002631. PMID: 35346971; PMCID: PMC8961140.
US 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 methods
Veterans (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.
Intention-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.
A 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.
Significance of this study
What is already known about this subject?
Diabetes distress related to the burden of diabetes self-care is an independent predictor of diabetes outcomes.
Emerging studies of mindfulness-based interventions have shown efficacy in reducing diabetes distress, but research is limited in populations at risk, including US military veterans.
What are the new findings?
A targeted mindfulness intervention integrated into conventional diabetes care is feasible, acceptable, and more efficacious for improving general dietary behaviors and for reducing diabetes distress after 12 weeks compared with conventional care.
Reductions in diabetes distress were greater with baseline hemoglobin A1C <8.5% (69 mol/mol), which may be relevant in selecting appropriate patients for mindfulness-based diabetes interventions.
Use of mobile technologies may help persons remain engaged in mindfulness practice and contribute to longer-term positive diabetes outcomes.
How might these results change the focus of research or clinical practice?
These results might influence standards of diabetes care to include mindfulness training as an adjunct to diabetes self-management education and support for suitable candidates.
Replication of these results with virtual delivery might help expand access to mindfulness-based educational programs for veterans and other persons at risk of diabetes and diabetes distress.