Effectiveness of a nurse‐led mindfulness stress‐reduction intervention on diabetes distress, diabetes self‐management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial

Abstract

People with diabetes frequently have elevated diabetes distress. Although mindfulness‐based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse‐led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse‐led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self‐efficacy, and diabetes self‐management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse‐led MBSR therapy had a significant time‐by‐group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58–0.77, p < 0.001), diabetes self‐efficacy (95% CI: −0.93 to −0.74, p < 0.001), diabetes self‐management (95% CI: −10.80 to −7.83, p < 0.001), and HbA1c levels (95% CI: 0.04–1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse‐led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse‐led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.

Effects of Meditation Intervention on Self-management in Adult Patients With Type 2 Diabetes

“…Figure 2 presents the risk of bias in the studies included. Overall, 4 of 9 studies showed low bias, 26,42,44,45 whereas 5 studies showed some concerns. [27][28][29]43,46,47 In the domain of Randomization Process, 5 studies showed low risk of bias, 26,42,[44][45][46] whereas 4 studies showed some concerns, mainly related to lack of clear information about concealment of allocation sequence.…”

“…28,29 Thus, 9 studies were used in this review. Eight of the studies were 2-arm RCTs, [26][27][28][29]42,43,[45][46][47] and 1 study was a 3-arm RCT. 44 As addressed previously, in the meta-analysis, 2 of the 3 arms (the intervention group and usual care group) were used.…”

“…27 The proportions of men in individual studies presented ranged from 0% 45 to 78.2%. 28 Mindfulness-based stress reduction programs were the most commonly provided (5 studies) 26,28,29,42,44,45 followed by mindfulness meditation programs (3 studies) 27,46,47 and mindfulness-based cognitive therapy (1 study). 43 The interventionists in the studies included a certified instructor, registered nurse with training or supervision by a certified expert, psychologist, therapist, or researcher with training.…”

“…43 The interventionists in the studies included a certified instructor, registered nurse with training or supervision by a certified expert, psychologist, therapist, or researcher with training. [26][27][28][29][42][43][44][45] In 1 study, 46 a self-directed audio compact disc was used as the intervention delivery method, and in another study, 47 the information was not clearly presented. Except for 1 study, 46 the number of sessions ranged from 8 to 10 sessions.…”

“…Hemoglobin A 1c was the most common outcome (8 studies), [26][27][28][29]42,43,[45][46][47] followed by fasting blood glucose (4 studies), 26,28,44,45,47 mean systolic and diastolic blood pressure (2 studies), 29,46 maximum systolic and diastolic blood pressure (1 study), 28 diabetes self-management (1 study), 42 body mass index (1 study), 28 total cholesterol (1 study), 28 low-density lipoprotein cholesterol (1 study), 28 high-density lipoprotein cholesterol (1 study), 28 triglycerides (1 study), 28 diet (1 study), 46 exercise (1 study), 46 foot care (1 study), 46 and monitoring of blood glucose (1 study). 46 However, HbA 1c and fasting blood glucose values at follow-ups in 1 study were not presented, 26 resulting in no inclusion of this study to the meta-analysis.…”