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.

Purpose The purpose of the study was to explore an understanding of the psychosocial-behavioral impact of diabetes self-management among veterans with diabetes. Methods Twenty-six veterans participated in 1 of 9 focus groups that were conducted following a group diabetes self-management education class and prior to a mindfulness intervention as part of a feasibility pilot study. Discussions were guided by open-ended questions that addressed the overarching research question, “How do attitudes and experiences with diabetes inform psychosocial-educational approaches to diabetes self-management education and care for veterans?” Focus groups were audio-recorded and transcribed. The data was then independently coded and thematically analyzed by 2 coders. Results Five main themes that reflect veterans’ perceptions of their experiences with diabetes and diabetes self-management were identified: (1) distress and negative emotions, (2) social isolation, (3) perceived lack of control, (4) attitudes toward diabetes support, and (5) desire for information about stress, diabetes, health, and behavior. Conclusions Veterans experience emotional distress and have unmet psychosocial needs related to diabetes self-management. Insight gained from these veteran perspectives suggests a framework for integrating psycho-educational interventions like mindfulness into diabetes care that emphasize stress reduction, person-centered communication, and opportunities for peer support.

Introduction Sleep health is often compromised among individuals undergoing cardiac rehabilitation and does not consistently improve over the course of treatment. Behavioral sleep and circadian interventions may improve the sleep health of cardiac rehabilitation patients but have not been widely tested in this context. We conducted a preliminary test of an adapted version of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) with Veterans in cardiac rehabilitation to evaluate its acceptability with these unique patients. Methods Eight Veterans with sleep disturbance and/or sleep-related impairment who were participating in outpatient cardiac rehabilitation completed the adapted TranS-C intervention and post-intervention acceptability measures. Intervention acceptability was assessed quantitatively with subscales from the Multidimensional Treatment Satisfaction Measure (subscale scores range from 0-4; higher scores indicate greater satisfaction) and qualitatively via semi-structured interviews. We calculated descriptive statistics for quantitative measures and analyzed semi-structured interviews using a rapid qualitative analysis approach. Results Participants felt the intervention was suitable to their needs (M=3.00, SD=.94) and useful for increasing their knowledge and understanding of sleep problems and how to manage them (M=3.50, SD=.69). Participants endorsed positive attitudes toward the intervention (M=3.63, SD=.58) and high likelihood of recommending the intervention to others similarly experiencing sleep problems (M=3.63, SD =.58). Following the intervention, 62.5% of participants indicated that their sleep disturbance and sleep-impairment were ‘much better’ than at the first study visit and 37.5% indicated their sleep disturbance and sleep-related impairment were ‘somewhat better’. Qualitative findings converged with the noted quantitative findings. Conclusion Veteran cardiac rehabilitation patients expressed satisfaction and positive attitudes toward the adapted TranS-C intervention. All participants reported subjective post-intervention improvements in sleep disturbance and sleep-related impairment. These findings provide preliminary support for further large-scale testing of adapted TranS-C in cardiac rehabilitation. Support (if any) Dr. Tighe is supported by a Career Development/Capacity Building Award (IK2 RX003393) from the United States Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service. This material is the result of work supported with resources and use of facilities at the VISN 4 Mental Illness Research, Education, and Clinical Center at VA Pittsburgh Healthcare System.